Risk factors of multiple bronchoalveolar lavage therapy in children with mycoplasma pneumonia complicated with atelectasis

Abstract

Objective To explore the risk factors of multiple bronchoalveolar lavages (BAL) in children with Mycoplasma pneumoniae pneumonia (MPP) complicated with atelectasis. Methods A case-control trail was designed to analyze the clinical data of 306 children with MPP complicated with atelectasis in the Respiratory Center of Children's Hospital of Chongqing Medical University from February 2017 to March 2020. All cases were divided into single group (n=201) and multiple group (≥ 2 times, n=105) based on the total number of BAL undertaken. Univariate and multivariate analyses were used to analyze the risk factors of multiple BALs. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of clinical course before BAL and lactate dehydrogenase (LDH) for multiple BALs. Results Univariate analysis showed that there were significant differences in the incidence of extrapulmonary complications, pleural effusion, left lower lobe atelectasis, stenosis of the lumen or opening of the bronchus, formation of bronchial mucus plug and use of systemic glucocorticoid between the 2 group (P < 0.05). Statistical differences were in platelet (PLT) count, neutrophil percentage, levels of C-reactive protein (CRP), procalcitonin (PCT) and LDH, and clinical course before azithromycin therapy and clinical course before BAL (P < 0.05). Logistic regression analysis showed that clinical course before BAL (P=0.002, OR=1.033, 95%CI: 1.012~1.055), LDH (P < 0.001, OR=1.004, 95%CI: 1.002~1.006), use of systemic glucocorticoid (P < 0.001, OR=4.663, 95%CI: 2.534~8.584) and extrapulmonary complications (P=0.025, OR=2.09, 95%CI: 1.097~3.983) were the risk factors of multiple BALs in children with MPP complicated with atelectasis. The area under ROC curve of LDH was 0.734 (95%CI: 0.668~0.800, P < 0.01) and the optimal cutoff value was 374 U/L. The area under ROC curve of clinical course before BAL was 0.703 (95%CI: 0.668~0.800, P < 0.01) and the optimal cutoff value was 13.5 d. Conclusion Long clinical course before BAL, high LDH level, use of systemic glucocorticoid and extrapulmonary complications are the risk factors of multiple BALs in children with MPP complicated with atelectasis. BAL before the course is shorter than 13.5 d, and active anti-inflammatory therapy is beneficial to improve the clinical effect of these children.

Keywords

• mycoplasma pneumoniae pneumonia
• atelectasis
• bronchoalveolar lavage
• children