Impact of mycoplasma pneumonia with diarrhea on IL-4,IL-6,and other cytokines in children:construction and validation of a nomogram prediction model

ZHAO Chan; GAO Yuan

doi:10.13820/j.cnki.gdyx.20243051

Abstract：Objective To investigate the effects of mycoplasma pneumonia combined with diarrhea on cytokines such as IL-4 and IL-6 in children,and to construct and validate a nomogram prediction model for the risk of diarrhea in these patients.Methods From September 2021 to September 2023,300 children with mycoplasma pneumonia with com-plete clinical data were randomly selected using a random number table.They were divided into a modeling cohort(200 cases)and a validation cohort(100 cases).In the modeling cohort,patients were further categorized into a non-diarrhea group(150 cases)and a diarrhea group(50 cases);in the validation cohort,there were 76 non-diarrhea cases and 24 diarrhea cases.Clinical data were collected,and the predictive value of continuous variables was analyzed using receiver operating characteristic(ROC)curve analysis.Logistic regression was applied to identify risk factors,and a nomogram prediction model was constructed using R language.The model's performance was evaluated by ROC curves,calibration curves,and decision curve analysis(DCA).Additionally,changes in relevant cytokine levels were analyzed.Results Compared with the non-diarrhea group,the diarrhea group had a significantly higher proportion of patients with peak fe-ver ≥40℃ and a lower proportion with low complement status(P＜0.05).Moreover,the diarrhea group exhibited a lon-ger disease course,prolonged fever duration,extended antibiotic application time,and higher levels of interleukin(IL)-4,IL-6,and tumor necrosis factor-α(TNF-α)(P＜0.05),all of which were identified as risk factors.The con-structed nomogram demonstrated excellent discrimination,with a C-index of 0.997(95％CI:0.992-1.003).Decision curve analysis indicated that when the risk threshold was＞0.12,the model provided substantial net clinical benefit.Conclusion In children with mycoplasma pneumonia,the presence of peak fever ≥40℃,absence of low complement status,longer disease duration,extended fever and antibiotic treatment,and elevated levels of IL-4,IL-6,and TNF-α are associated with an increased risk of diarrhea.The nomogram prediction model shows excellent predictive capability and may serve as a valuable tool for early identification and risk stratification in clinical practice.