To investigate factors associated with pulmonary embolism (PE) in children with refractory Mycoplasma pneumoniae pneumonia (RMPP) and elevated D-dimer levels.
Approach:
Study Design: Children diagnosed with RMPP and suspected PE were enrolled from five hospitals in northern China between November 2023 and March 2024.
Data Collection: Blood samples were collected for inflammatory and immunological assessments, and patients were stratified into PE and non-PE groups based on computed tomographic pulmonary angiography (CTPA) findings.
Statistical Analysis: Univariate and multivariate logistic regression analyses were performed to identify factors associated with PE.
Key Findings:
49 out of 109 children (45.0%) with RMPP had PE (P < 0.001).
Higher white blood cell and neutrophil counts, and elevated D-dimer levels were observed in the PE group (P < 0.05).
Simultaneous positivity for lupus anticoagulant and antinuclear antibodies (P = 0.006), and left lower lobe consolidation (P = 0.002) were more frequent in the PE group.
Independent factors associated with PE included neutrophil count (OR, 1.221; 95% CI, 1.031–1.446), admission D-dimer levels (OR, 2.664; 95% CI, 1.485–4.778), simultaneous positivity for lupus anticoagulant and antinuclear antibodies (OR, 3.185; 95% CI, 1.234–8.223), and left lower lobe consolidation (OR, 5.016; 95% CI, 1.825–13.790).
Interpretation:
Among children with RMPP and elevated D-dimer levels, specific clinical and laboratory findings were independently associated with the occurrence of PE.
Limitations:
The study was conducted in a limited geographical area, which may affect the generalizability of the findings.
The sample size may not be large enough to draw definitive conclusions.
Conclusion:
Higher neutrophil counts, greater D-dimer elevation, simultaneous positivity for lupus anticoagulant and antinuclear antibodies, and left lower lobe consolidation were independently associated with PE in children with RMPP.
