{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T06:02:35Z","timestamp":1789970555896,"version":"4.0.1"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"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>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Mycoplasma pneumoniae<\/jats:italic>\n                      carries a clinically important risk of a refractory course or the need for intensified corticosteroid therapy. No admission-day prediction tool has been validated to identify children at risk for either outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Children admitted to a single tertiary centre with a diagnosis of MPP between January 2022 and June 2025 were enrolled in a retrospective cohort study. Two penalised logistic regression models were constructed from routine admission-day clinical and laboratory variables: one targeting RMPP occurrence across the full eligible cohort (Cohort A) and one targeting corticosteroid escalation within the treated subgroup (Cohort B). Candidate predictors were screened by LASSO-penalised regression, and model performance was optimism-corrected via bootstrap resampling. Discrimination, calibration, and clinical utility were assessed by corrected AUC, calibration metrics, and decision curve analysis, with nomograms derived from the final coefficients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 383 Cohort A patients, 106 met criteria for RMPP. Within Cohort B (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009197), 61 children (31.0%) required treatment escalation. The RMPP model retained nine admission-day variables, including pre-admission fever duration, log-transformed CRP, LDH, D-dimer, ferritin, the neutrophil-to-lymphocyte ratio, albumin, male sex, and pleural effusion, and yielded an optimism-corrected AUC of 0.847 (95% CI: 0.810\u20130.886). The escalation model retained four variables (LDH, NLR, ferritin, and CRP), with a corrected AUC of 0.799 (95% CI: 0.747\u20130.861). Both models achieved good calibration and positive net clinical benefit across decision thresholds from 5% to 60%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study offers a quantitative framework for stratifying children with MPP by their risk of refractory disease and treatment intensification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1913556","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:34:44Z","timestamp":1789968884000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prediction models for refractory Mycoplasma pneumoniae pneumonia and corticosteroid treatment escalation in hospitalized children: a retrospective cohort study"],"prefix":"10.3389","volume":"14","author":[{"given":"Yueqian","family":"Li","sequence":"first","affiliation":[{"name":"Third Department of Pediatrics, Handan First Hospital","place":["Handan, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinan","family":"Shen","sequence":"additional","affiliation":[{"name":"Third Department of Pediatrics, Handan First Hospital","place":["Handan, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Shi","sequence":"additional","affiliation":[{"name":"Third Department of Pediatrics, Handan First Hospital","place":["Handan, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanwei","family":"Li","sequence":"additional","affiliation":[{"name":"Third Department of Pediatrics, Handan First Hospital","place":["Handan, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Li","sequence":"additional","affiliation":[{"name":"Third Department of Pediatrics, Handan First Hospital","place":["Handan, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junfeng","family":"Liu","sequence":"additional","affiliation":[{"name":"Third Department of Pediatrics, Handan First Hospital","place":["Handan, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1128\/CMR.00114-16","article-title":"Mycoplasma pneumoniae from the respiratory tract and beyond","volume":"30","author":"Waites","year":"2017","journal-title":"Clin Microbiol Rev"},{"key":"B2","doi-asserted-by":"publisher","first-page":"101200","DOI":"10.1016\/j.lanmic.2025.101200","article-title":"Macrolide-resistant Mycoplasma pneumoniae 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