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The patients were categorised into three groups: MPP only, MPP with bacterial co-infection, and MPP with viral co-infection. Clinical and laboratory data were analysed. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curves. Machine learning models with Boruta feature selection and 5-fold cross-validation were applied for co-infection classification. Statistical significance was set at\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Significant differences were observed between groups. The bacterial co-infection group had higher white blood cell and platelet counts and elevated levels of interferon-alpha, interleukin-1 beta, interleukin-6, and tumour necrosis factor-alpha (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). The viral co-infection group had lower interleukin-12P70 levels, longer fever and cough durations, and higher lactate dehydrogenase levels (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). Correlation analysis showed strong associations between white blood cells, platelets, and proinflammatory cytokines. ROC analysis of single parameters showed modest discrimination: for bacterial co-infections the best single marker was interferon-alpha with an AUC of 0.774 (95% CI 0.649\u20130.899), whereas for viral co-infections the best was lactate dehydrogenase with an AUC of 0.684 (95% CI 0.563\u20130.806). In contrast, machine learning models achieved higher performance, reaching an AUC of 0.868 (95% CI 0.772\u20130.964; SVM) for bacterial co-infections and 0.753 (95% CI 0.636\u20130.870; LightGBM) for viral co-infections.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The combination of clinical data, laboratory parameters and cytokine profiles may improve the early diagnostic accuracy of MPP with bacterial or viral co-infections in some patients, and potentially guide optimised treatment strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12887-026-06992-3","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T02:36:46Z","timestamp":1778726206000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic value of cytokine detection in children with Mycoplasma pneumoniae pneumonia complicated by bacterial or viral co-infections"],"prefix":"10.1186","volume":"26","author":[{"given":"ChenYe","family":"Lin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ZhiRong","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yadong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JianXing","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ZhiNan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanbin","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"QiuYu","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Lian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"6992_CR1","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1111\/crj.136202","volume":"17","author":"F Fei","year":"2023","unstructured":"Fei F, Jun L, Qianyuan Y, Fei J. 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