Risk factors for bronchiolitis obliterans development in children after Mycoplasma pneumoniae pneumonia: a retrospective study of 981 patients

Abstract

Background: Bronchiolitis obliterans (BO) is a rare and severe chronic pulmonary condition in children following an injury to lower respiratory tract lesion. Mycoplasma pneumoniae (M. pneumoniae) is the second etiology of post-infectious bronchiolitis obliterans (PIBO). The aim of this study was to determine risk factors for PIBO development in children after M. pneumoniae pneumonia. Methods: This retrospective study enrolled 981 children admitted to Beijing children’s hospital due to M. pneumoniae pneumonia between January 2016 and December 2022. The medical records of the PIBO and non-PIBO groups, including demographic, clinical, radiologic, and laboratory data were analyzed by multivariate logistic regression to reveal PIBO development-associated risk factors. Results: Seventy-two of the study patients developed PIBO after M. pneumoniae pneumonia. Multivariate analysis showed that large lobar consolidation (OR 4.06, 95% CI 1.18–14.03), diffuse bronchiolitis (OR 11.78, 95% CI 3.28–42.22), co-infection (OR 3.65, 95% CI 1.60–8.33), atopic conditions (OR 12.32, 95% CI 5.2–29.11), bronchial mucus plug (OR 2.48, 95% CI 1.10–5.58), CPR (OR 1.01, 95% CI 1.00–1.02), mechanical ventilation (OR 2.95, 95% CI 1.00–8.67), and duration of fever (OR 1.19, 95% CI 1.05–1.37) were significantly associated with development of PIBO after M. pneumoniae pneumonia. Conclusions: In children with M. pneumoniae pneumonia, large lobar consolidation, diffuse bronchiolitis, co-infections, atopic conditions, bronchial mucus plug, CRP, mechanical ventilation, and duration of fever appeared as prominent independent risk factors for PIBO. Timely application of HRCT could provide a basis for the early prediction of PIBO development in children.