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The aim of this study was to establish a linear model for predicting necrotizing pneumonia (NP) caused by\n                      <jats:italic>Mycoplasma pneumoniae<\/jats:italic>\n                      (MP) infection and to investigate the risk factors for lung necrosis in children with refractory\n                      <jats:italic>Mycoplasma pneumoniae<\/jats:italic>\n                      pneumonia (RMPP).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 536 children with RMPP were enrolled, including 95 with NP and 441 with nonnecrotizing pneumonia (NNP). A prediction model was built on 375 cases and validated on 161 cases, which were divided by random sampling in R software. Multivariate logistic regression was performed to determine optimal predictors and to establish a nomogram for predicting NP. The performance of the nomogram was evaluated by the area under the characteristic curve (AUC), calibration ability and decision curve analysis (DCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 315 (84.0%) NNP patients and 60 (16.0%) NP patients in the training group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009375) and 126 (78.3%) NNP patients and 35 NP patients (21.7%) in the validation group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009161). Multivariate logistic regression analysis identified 4 independent predictors that were used to construct a nomogram for predicting NP in children with RMPP, namely, fever duration (AOR\u2009=\u20091.475; 95% CI 1.296\u20131.678;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), WBC count (AOR\u2009=\u20091.149; 95% CI 1.073\u20131.231;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), IL-6 concentration (AOR\u2009=\u20091.007; 95% CI 1.002\u20131.013;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.007) and D-dimer concentration (AOR\u2009=\u20091.361; 95% CI 1.121\u20131.652;\n                      <jats:italic>P\u2009=<\/jats:italic>\n                      \u20090.002). The area under the curve (AUC) of the nomogram was 0.899 (95% CI, 0.850\u20130.947) in the training set and 0.920 (95% CI, 0.874\u20130.966) in the validation set, indicating a good fit. The calibration plot and Hosmer\u2012Lemeshow test indicated that the predicted probability had good consistency with the actual probability in the training (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.439) and validation (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.526) groups. The DCA curve demonstrated a significantly better net fit in the model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We developed and validated a nomogram model for predicting RMPP-associated NP in its early clinical stages based on fever duration, WBC count, IL-6 and D-dimer concentration. This four-risk factor model may assist physicians in predicting NP induced by RMPP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13052-025-02006-7","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T11:11:10Z","timestamp":1747825870000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Development and validation of a nomogram for predicting necrotizing pneumonia in children with refractory Mycoplasma pneumoniae pneumonia"],"prefix":"10.1186","volume":"51","author":[{"given":"Xiaoying","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihua","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojian","family":"Cui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongsheng","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tongqiang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Ning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,21]]},"reference":[{"issue":"3","key":"2006_CR1","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1128\/CMR.00114-16","volume":"30","author":"KB Waites","year":"2017","unstructured":"Waites KB, Xiao L, Liu Y, Balish MF, Atkinson TP. 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