{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T23:03:20Z","timestamp":1793228600523,"version":"4.5.0"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>With the increase of the incidence rate of <jats:italic>Mycoplasma pneumoniae<\/jats:italic> in children and the widespread use of azithromycin, the number of cases of refractory <jats:italic>M. pneumoniae<\/jats:italic> increased accordingly. <jats:italic>M. pneumoniae<\/jats:italic> infection was generally considered a self-limiting disease. However, under certain special circumstances, it was highly likely to develop into a refractory disease. This study conducted a meta-analysis of early risk factors for refractory <jats:italic>Mycoplasma pneumoniae<\/jats:italic> pneumonia (RMPP), which was helpful for the early clinical diagnosis of RMPP and the reduction of sequelae.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This systematic search was conducted in Web of Science, Embase, PubMed, Cochrane Library, CNKI, Wangfang, Sinomed and Cqvip, and the date was set until August 20, 2024. After two researchers independently screened the literature, extracted data, and assessed the risk of bias in the included studies, a meta-analysis was conducted using STATA 17.0 and RevMan 5.4 software.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty-eight studies including 6374 patients were included in this analysis, and the results showed that the age [<jats:italic>MD (95% CI)<\/jats:italic>: 0.62 (0.21, 1.03), <jats:italic>P<\/jats:italic>\u2009=\u20090.003], LDH [<jats:italic>MD (95% CI<\/jats:italic>): 161.57 (128.22, 194.91), <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001], neutrophils (%) [<jats:italic>MD (95% CI<\/jats:italic>): 9.27 (3.45, 15.09), <jats:italic>P<\/jats:italic>\u2009=\u20090.002], IL-6 [<jats:italic>MD (95% CI<\/jats:italic>): 23.07 (20.90, 25.24), <jats:italic>P<\/jats:italic>\u2009=\u20090.04], ESR [<jats:italic>MD (95% CI<\/jats:italic>): 10.93 (7.75, 14.11), <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001], AST [<jats:italic>MD (95% CI<\/jats:italic>): 16.11 (8.21, 24.01), <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001], ALT [<jats:italic>MD (95% CI<\/jats:italic>): 23.69 (9.60, 37.77), <jats:italic>P<\/jats:italic>\u2009=\u20090.001], CRP [<jats:italic>MD (95% CI<\/jats:italic>): 23.72 (18.41, 29.03), <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001], and WBC [<jats:italic>MD (95% CI<\/jats:italic>): 1.07 (0.28, 1.86), <jats:italic>P<\/jats:italic>\u2009=\u20090.008] were higher in the RMPP group than in the NRMPP group. Combined pleural effusion (<jats:italic>OR<\/jats:italic>\u2009=\u20097.59, <jats:italic>95% CI<\/jats:italic>: 4.19\u201313.75, <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001) and lung consolidation (<jats:italic>OR<\/jats:italic>\u2009=\u200910.61, <jats:italic>95% CI<\/jats:italic>: 4.13\u201327.26, <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001) were identified as risk factors for RMPP. However, no significant association was found between gender and the incidence of RMPP (<jats:italic>OR<\/jats:italic>\u2009=\u20090.91, <jats:italic>95% CI<\/jats:italic>: 0.80\u20131.02, <jats:italic>P<\/jats:italic>\u2009=\u20090.10). The analysis of publication bias indicated that 3 of the 11 factors analyzed [LDH, neutrophils (%), and lung consolidation] showed significant publication bias (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our study further confirmed that elevated inflammatory markers such as CRP, LDH, neutrophils (%), IL-6, ESR, lung consolidation, combined pleural effusion were risk factors for RMPP. For the first time, WBC, ALT, and AST were identified as risk factors for the occurrence of RMPP in children. Additionally, demographic information such as age and gender was also examined in relation to RMPP in children.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1512689","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T05:32:45Z","timestamp":1751002365000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Risk factors for refractory Mycoplasma pneumoniae in Chinese children: a meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Chun","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanzhong","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luohui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuejuan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1080\/21505594.2021.1889813","article-title":"Infection strategies of mycoplasmas: unraveling the panoply of virulence factors","volume":"12","author":"Chen","year":"2021","journal-title":"Virulence"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e002","DOI":"10.1128\/iai.00248-23","article-title":"Aerobic glycolysis of bronchial epithelial cells rewires M. pneumoniae pneumonia and promotes bacterial elimination","volume":"92","author":"He","year":"2024","journal-title":"Infect Immun"},{"key":"B3","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1007\/s00284-022-03103-0","article-title":"Insight into the pathogenic mechanism of Mycoplasma pneumoniae","volume":"80","author":"Hu","year":"2022","journal-title":"Curr Microbiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1111\/imm.13346","article-title":"Biological functions of IL-17-producing cells in mycoplasma respiratory infection","volume":"164","author":"Luo","year":"2021","journal-title":"Immunology"},{"key":"B5","doi-asserted-by":"publisher","first-page":"79","DOI":"10.3760\/cma.j.cn331340-20230217-00023","article-title":"Guidelines for the diagnosis and treatment of M. pneumoniae pneumonia in children (2023 edition)","volume":"50","year":"2023","journal-title":"J Int J Epidemiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"152077","DOI":"10.1016\/j.imbio.2021.152077","article-title":"T-B cell epitope peptides induce protective immunity against mycopla- sma pneumoniae respiratory tract infection in BALB\/c mice","volume":"226","author":"Chen","year":"2021","journal-title":"Immunobiology"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e375","DOI":"10.1097\/MD.0000000000037521","article-title":"Research status and challenges of M. pneumoniae pneumonia in children: a bibliometric and visualization analysis from 2011 to 2023","volume":"103","author":"Liu","year":"2024","journal-title":"Medicine"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2059","DOI":"10.1038\/s41598-021-81853-w","article-title":"The relationships between LncRNA NNT-AS1, CRP, PCT and their interactions and the refractory M. pneumoniae pneumonia in children","volume":"11","author":"Chen","year":"2021","journal-title":"Sci Rep"},{"key":"B9","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/s12879-020-05700-5","article-title":"Clinical significance of D-dimer levels in refractory M. pneumoniae pneumonia","volume":"21","author":"Huang","year":"2021","journal-title":"BMC Infect Dis"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1168","DOI":"10.7507\/1672-2531.202106161","article-title":"Risk factors for refractory m ycoplasm a pneum oniae pneum onia in children: a systematic review","volume":"21","author":"Han","year":"2021","journal-title":"Chin J Evid Based Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"9227838","DOI":"10.1155\/2022\/9227838","article-title":"Refractory M. pneumoniae in children: a systematic review and meta-analysis of laboratory features and predictors","volume":"202","author":"Huang","year":"2022","journal-title":"J Immunol Res"},{"key":"B12","doi-asserted-by":"publisher","first-page":"112","DOI":"10.7499\/j.issn.1008-8830.2020.02.006","article-title":"Value of lactate dehydrogenase in predicting refractory M. 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