DYNAMIC MULTIPLEX CYTOKINE PROFILING TO IDENTIFY RISK FACTORS FOR LUNG CONSOLIDATION AND NECROTIZING TRANSFORMATION IN CHILDREN WITH MYCOPLASMA PNEUMONIAE PNEUMONIA

Background: Radiologic complications of pediatric Mycoplasma pneumoniae pneumonia (MPP), consolidation and necrotizing pneumonia (NP), are difficult to anticipate early. We tested whether admission cytokines and short‑term changes predict imaging outcomes.

Methods: A retrospective cohort (Oct 2022–Sep 2024) of hospitalized children with PCR‑confirmed MPP. Multiplex cytokines (including IL‑6, IL‑10, CXCL10/IP‑10) were assayed from residual samples at admission (T0) and days 3–5 (T1). Primary outcomes were WHO end‑point CXR consolidation ≤14 days and CT‑defined NP ≤28 days. Penalized logistic models evaluated T0 and Δ(T0-T1) predictors among children event‑free at T1, with AUC (bootstrap‑corrected) and BH‑FDR control.

Results: Of 286 enrollments, 268 were analyzed with consolidation occurred in 96/268 (35.8%), CT were performed in 124/268 (46.3%) and identified NP in 28/124 (22.6%; 10.4% overall). In the Admission model, IL‑6 (adjusted OR [aOR] 1.45, 95% CI 1.16–1.83; q=0.01), IP‑10 (1.52, 1.21–1.93; q<0.01), and IL‑10 (1.28, 1.03–1.60; q=0.04) predicted consolidation (AUC 0.78, 95% CI 0.73–0.83). In event‑free children at T1 (n=180), ΔIL‑6 (1.40, 1.12–1.76) and ΔIP‑10 (1.48, 1.18–1.88) improved discrimination (AUC 0.84, 0.79–0.88). In CT‑subset models, T0 IL‑6 (1.67, 1.09–2.58) and ΔIL‑6 (1.89, 1.22–3.00) were associated with NP (AUC 0.79). Findings were robust in prespecified sensitivity analyses.

Conclusions: Admission cytokines and early rises, especially IL‑6 and IP‑10, enable pragmatic early risk stratification for consolidation, with ΔIL‑6 also signaling NP risk. These results support external validation of a cytokine‑based tool to inform imaging and triage.