The Role of NLR and Ferritin Levels as Biomarkers for Corticosteroid Dosage in Children with Refractory Mycoplasma Pneumoniae Pneumonia

Caili Guo, Yibing Cheng, Chunlan Song, Xiaowen Wang, Yuanzhe Li Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, Henan, 450018, People’s Republic of ChinaCorrespondence: Yuanzhe Li, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, 33 East Waihuan Road, Longhu, Zhengzhou, Henan, 450018, People’s Republic of China, Tel +86-13598093620, Email [email protected]: This study aims to explore the relationship between RMPP biomarkers and the dose of glucocorticoids.Patients and Methods: A retrospective analysis was conducted on 432 children with refractory Mycoplasma pneumoniae pneumonia (RMPP) who visited the Children’s Hospital from January 2023 to December 2024. According to the dose of methylprednisolone, it was divided into three groups: low-dose, medium-dose and high-dose. We evaluated the basic characteristics, laboratory results and imaging manifestations of the patients.Results: The median age and body mass index (BMI) of patients in the high-dose group were the lowest, which were 6.5 years (5, 8.25) and 14.25 years (13.28, 15.23), respectively. The imaging manifestations were more obvious in the high-dose group. The hospitalization time was the longest and the hospitalization cost was the highest (P< 0.05). Furthermore, in the high-dose RMPP cohort, White blood cell count (WBC), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), alanine aminotransferase (ALT), creatine kinase MB (CKMB), lactate dehydrogenase (LDH), fibrinogen, The levels of D-dimer, ferritin, procalcitonin (PCT) and erythrocyte sedimentation rate (ESR) were all significantly increased (P< 0.05). The dose of glucocorticoids was positively correlated with the length of hospital stay, BMI, WBC, CRP, PCT, LDH, ALT, NLR, ESR, D-dimer and ferritin levels. But there was no significant correlation with age. The correlation coefficients of NLR, ferritin and the dose of methylprednisolone were the highest, with Spearman ρ values of 0.451 and 0.592 respectively (P< 0.001).Conclusion: NLR and ferritin levels may be useful biomarkers for determining the appropriate dose of corticosteroids in children with RMPP. Keywords: Mycoplasma pneumoniae, neutrophil-to-lymphocyte ratio (NLR), ferritin, glucocorticoid, children