Dynamic multiplex cytokine profiling to identify risk factors for lung consolidation and necrotizing transformation in children with Mycoplasma pneumoniae pneumonia

Background: 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). NP analyses were conditional on undergoing computed tomography (CT). Primary outcomes were WHO end-point CXR consolidation ≤14 days and CT-defined NP ≤28 days. Full-cohort 14-day CXR-consolidation risk (admission), post-T1 consolidation risk among event-free children (day 3-5 landmark), and 28-day NP risk conditional on being scanned. 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; consolidation occurred in 96/268 (35.8%), CT was 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