The Value of Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) and High Mobility Group Box 1 (HMGB1) as Auxiliary Indicators in Childhood Refractory Mycoplasma Pneumoniae Pneumonia

Abstract

Background and objective: Early diagnosis and timely management of refractory Mycoplasma pneumoniae pneumonia (MPP) helps improve the prognosis of patients. The aim of this study was to explore the relationship between the peripheral granulocyte-macrophage colony-stimulating factor (GM-CSF), high mobility group box 1 (HMGB1) and the clinical features as well as the prognosis of children with refractory MPP. Methods: A total of 130 MPP children were enrolled. They were divided into two groups based on the clinical diagnosis: Refractory MPP group (n = 57) included children whose clinical and radiological features deteriorated despite receiving appropriate antibiotic treatment for more than 7 days;And Non-refractory group (n = 73) which included the other children. Clinical data, including physical examination, treatment and outcome, were collected. The peripheral GM-CSF and HMGB1 level before and after treatment were determined, through enzyme-linked immunosorbent sorbent assay (ELISA) kits. Results: Compared with the non-refractory MPP group, the level of GM-CSF and HMGB1 were significant higher in the refractory MPP group (p < 0.05). The receiver operator characteristic (ROC) curve analysis results indicated that GM-CSF and HMGB1 levels before treatment can predict refractory MPP attack (area under the curve, AUC = 0.706, 0.665, p < 0.05). The combined predictive value of the GM-CSF and HMGB1 levels for refractory MPP attack was higher than their independent predictive value (AUC = 0.776). Moreover, the levels of GM-CSF and HMGB1 at 1 week after treatment could predict long hospital stay (>28 d) (AUC = 0.738, 0.776, p < 0.05) and poor prognosis of refractory MPP (AUC = 0.817, 0.804, p < 0.05). Conclusions: GM-CSF and HMGB1 can predict the occurrence and development of refractory MPP, thus, they can be used as the auxiliary indicators for clinic diagnoses and prognosis in patients, providing specific guidance for an appropriate clinical treatment.