Diagnostic value of cytokine detection in children with Mycoplasma pneumoniae pneumonia complicated by bacterial or viral co-infections.
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BACKGROUND: To evaluate the diagnostic value of cytokine levels in paediatric patients with Mycoplasma pneumoniae pneumonia (MPP) complicated by bacterial or viral infections, to enhance early detection and treatment strategies. METHODS: A retrospective analysis was conducted on 145 paediatric patients with MPP at Fujian Children's Hospital between October 2023 and April 2024. The patients were categorised into three groups: MPP only, MPP with bacterial co-infection, and MPP with viral co-infection. Clinical and laboratory data were analysed. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curves. Machine learning models with Boruta feature selection and 5-fold cross-validation were applied for co-infection classification. Statistical significance was set at P < 0.05. RESULTS: Significant differences were observed between groups. The bacterial co-infection group had higher white blood cell and platelet counts and elevated levels of interferon-alpha, interleukin-1 beta, interleukin-6, and tumour necrosis factor-alpha (all P < 0.05). The viral co-infection group had lower interleukin-12P70 levels, longer fever and cough durations, and higher lactate dehydrogenase levels (all P < 0.05). Correlation analysis showed strong associations between white blood cells, platelets, and proinflammatory cytokines. ROC analysis of single parameters showed modest discrimination: for bacterial co-infections the best single marker was interferon-alpha with an AUC of 0.774 (95% CI 0.649-0.899), whereas for viral co-infections the best was lactate dehydrogenase with an AUC of 0.684 (95% CI 0.563-0.806). In contrast, machine learning models achieved higher performance, reaching an AUC of 0.868 (95% CI 0.772-0.964; SVM) for bacterial co-infections and 0.753 (95% CI 0.636-0.870; LightGBM) for viral co-infections. CONCLUSION: The combination of clinical data, laboratory parameters and cytokine profiles may improve the early diagnostic accuracy of MPP with bacterial or viral co-infections in some patients, and potentially guide optimised treatment strategies.