ASSOCIATION BETWEEN PRE-ADMISSION 48-HOUR FEVER BURDEN AND OUTCOMES IN PEDIATRIC MYCOPLASMA PNEUMONIAE INFECTION
PRE-ADMISSION 48-HOUR FEVER BURDEN AND OUTCOMES IN PEDIATRIC MYCOPLASMA PNEUMONIAE
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Background: Refractory and severe evolution complicate pediatric Mycoplasma Pneumoniae pneumonia(MPP), yet early risk stratification still relies largely on single-time admission biomarkers. We tested whether a prespecified 48-hour pre-admission fever-burden index (FBI48) predicts in-hospital outcomes and improves model performance beyond guideline‑consistent clinical and laboratory predictors.
Methods: We conducted a retrospective single-center cohort study of hospitalized children ≤14 years with laboratory-confirmed MPP. FBI48 was defined as the area under the temperature–time curve above 38.0 °C over −48 to 0 h (°C·h). Thresholds of 38.5 °C and 39.0 °C were evaluated in sensitivity analyses. Prespecified covariates, chosen based on prior RMPP/SMPP studies and pediatric CAP/MPP guidelines, included age, illness days, SpO2, imaging severity, prior macrolide exposure, antipyretic and steroid use, LDH, log2-transformed NLR, CRP, and PCT. Penalized logistic regression generated predicted risks, while unpenalized models provided adjusted odds ratios. Model performance (AUC, Brier score, calibration) and decision-curve analysis (DCA) net benefit were assessed for base (clinical + laboratory) and augmented (base + FBI48) models across 10–30% risk thresholds.
Results: Of 720 eligible hospitalizations, 648 were analyzed. The composite endpoint (RMPP and/or incident SMPP) occurred in 176/648 (27.2%; RMPP 24.7%; SMPP 8.0%). FBI48 was independently associated with the composite endpoint (adjusted odds ratio [aOR] 1.45, 95% CI 1.25–1.68 per 1 SD ≈22 °C·h) and with SMPP alone (aOR 1.58, 95% CI 1.21–2.06). Adding FBI48 to the base model improved AUC from 0.78 to 0.83 (ΔAUC 0.05, p<0.001), reduced the Brier score (0.176 to 0.164, p=0.006), and increased net benefit compared with the base model and a treat-none strategy across 10–30% thresholds. Alternative fever thresholds (38.5 °C/39.0 °C) yielded similar effect sizes.
Conclusions: A simple 48-hour pre-admission fever-burden metric provides independent and incremental prognostic information for refractory or severe evolution of pediatric MPP, complementing guideline-based clinical and laboratory predictors and supporting early triage decisions. External validation and prospective evaluation of dynamic, in-hospital updating are warranted.
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