Investigation on the occurrence of liver damage and related influencing factors in children with mycoplasma pneumoniae pneumonia

Objective To analyze the occurrence of liver damage in children with mycoplasma pneumoniae pneumoniae (MPP), and explore its related influencing factors, establish a predictive model to explore its predictive value for providing the reference in guiding the clinical rational development of nursing countermeasures.

Methods A total of 293 children with MPP were retrospectively collected, and divided into the occurrence group and non-occurrence group according to the occurrence of liver damage. Univariate and logistic regression analysis were used to analyze the influencing factors of liver damage in children with MPP, and a predictive model was established to explore its predictive value.

Results There were 51 cases of liver damage in 293 cases, with an incidence of 17.41%. The results of logistic regression analysis showed that the fever duration ≥7 d (OR = 3.367, 95%CI = 1.338 ~ 8.475), fever peak ≥39 ℃ (OR = 2.968, 95%CI = 1.385 ~ 6.363), application of macrolide antimicrobials (MA) after 5d of onset (OR = 2.869, 95%CI = 1.420 ~ 5.799), involvement of myocardium (OR = 2.210, 95%CI = 1.201 ~ 4.066), level of peripheral blood white blood cell count (WBC) ＞10 × 10⁹/L (OR = 2.514, 95%CI = 1.249 ~ 5.062), level of serum C-reactive protein (CRP) ＞10 mg/L (OR = 2.012, 95%CI = 1.325 ~ 3.054), and level of serum albumin (ALB) ＜35 g/L (OR = 1.817, 95%CI = 1.185 ~ 2.785) were the independent risk factors of liver damage in children with MPP (P ＜ 0.05). A prediction model was established: logit (P) = -7.023 + fever duration≥7 d × 1.214 + fever peak ≥39 ℃ × 1.088 + application of MA after 5 d of onset × 1.054 + involvement of myocardium × 0.793 + WBC ＞ 10 × 10⁹/L × 0.922 + CRP ＞ 10 mg/L × 0.699 + ALB ＜ 35 g/L × 0.597. The Hosmer-Lemeshow goodness-of-fit test showed P＞0.05, suggesting that the fitting effect of the predictive model was good. The results of ROC curve analysis showed that when logit(P) ＞ 0.89, the area under the curve (AUC) value was 0.903, and the sensitivity and specificity were 86.27% and 79.75%, respectively.

Conclusions Children with MPP have certain liver damage phenomena. The risk factors involve fever duration ≥7 days, fever peak ≥39 ℃, application of MA 5 days after onset, involvement of myocardium, peripheral blood WBC level ＞10 × 10⁹/L, serum CRP level ＞10 mg/L and ALB level ＜35 g/L, etc. The predictive model established based on this has good predictive value. Clinically, reasonable nursing countermeasures can be formulated in a timely manner based on it to reduce the risk of liver damage in children with MPP.