Body’s temperature and respiratory tract signs and symptoms of subjects were examined at study entry and every 8 hour thereafter. Results The median age of the RMPP patients (n = 145) was much older than that of the GMPP patients (n = 489) (P 0.01). We also found more severe presentations, higher incidence of extra-pulmonary complications and more serious radiological findings in RMPP group, which needed oxygen more often, longer antibiotics administration and intensive care (P 0.05). Meanwhile, the levels of C-reactive protein (CRP), lactic dehydrogenase (LDH), Aminopterin immunoglobulin A (IgM), interleukin (IL)-6, IL-10, interferon gamma (IFN-) and the percentage of neutrophils, CD8+ in RMPP group were significantly higher than those in GMPP group (P 0.05); while the levels of prealbumin (PAB) were lower than that in GMPP group (P 0.01). In ROC curve analysis, the percentage of neutrophil, CRP, LDH, PAB, IL-6, IL-10 and IFN- were useful for differentiating patients with RMPP from those with GMPP. Multiple logistic regression analysis showed that the CRP16.5mg/L, LDH 417IU/L and IL-6 14.75pg/ml were significant predictors regarding to RMPP. Conclusions CRP16.5mg/L, LDH 417IU/L and IL-6 14.75pg/ml might be the significant predictors of Aminopterin RMPP in children, which can aid in early recognition of RMPP. Introduction (MP) is one of the most prevalent pathogens causing community-acquired pneumonia (CAP) in children [1, 2]. Prior studies showed that MP might account for as many as 40% of CAP cases and 18% of these patients require hospitalization [3]. Although pneumonia (MPP) is usually considered as a self-limited disease, sometimes it may cause various pulmonary and extra-pulmonary complications such as bronchiolitis obliterans, necrotizing pneumonia, encephalitis, arthritis, pericarditis, hemolytic anemia, and develop into a severe life-threatening pneumonia [4C11]. For children, macrolides are the first-choice antibiotics for MP infections. However, there still are some cases showing clinical and radiological deterioration despite Aminopterin of macrolide antibiotic therapy for 7 days or longer [12, 13] to be defined as refractory pneumonia (RMPP). Therefore, it is important for clinicians to recognize RMPP earlier and grasp the appropriate opportunity for reasonable therapy. In order to explore the predictive values of the independent related factors of RMPP, we retrospectively analyzed the cases of MPP hospitalized in our hospital between January 1, 2011 and December 31, 2014, then compared the differences of clinical features, laboratory data and radiological findings between RMPP and general pneumonia (GMPP) children. Methods Study population In this study we retrospectively collected the data of patients with MMP who admitted to Childrens hospital, Zhejiang University School of Medicine between January 1, 2011 and December 31, 2014. All the patients had signs and symptoms indicative of pneumonia on admission, including fever, cough, abnormal lung auscultation and a new infiltrate on chest radiograph [14]. The diagnosis of MP infection was based on the positive results for serologic test (MP IgM positive and antibody titer1:160) while having the positive results for MP polymerase chain reaction (PCR) tests of nasopharyngeal secretions. Aminopterin The diagnosis of RMPP was based on the presence of persistent fever and clinical as well as radiological deterioration after azithromycin treatment for 7 days or longer [12, 13]. All patients were excluded with other respiratory tract infections and tuberculosis by following tests: protein purified derivative (PPD), blood cultures, pleural effusion cultures, nasopharyngeal aspirate/swab cultures, nasopharyngeal aspirate/swab for virus antigens detection (respiratory syncytial viruses, influenza viruses, metapneumovirus, adenovirus, and parainfluenza virus), and Aminopterin serology for Chlamydia pneumoniae (CT) and Legionella pneumophila (LG). Patients who received corticosteroids before admission or had underlying diseases such Rabbit Polyclonal to OR1L8 as asthma, recurrent respiratory tract infection, chronic cardiac and pulmonary disease, rheumatic diseases and immunodeficiency were also excluded. Data collection Demographic, clinical information, laboratory data and radiological findings were retrospectively collected from all children who were included in the study. Nasopharyngeal aspirate/swab specimens were routinely collected within 24 hours of admission. Respiratory specimens were tested for bacterial culture, virus using direct immunofluorescence assays and MP using PCR. Peripheral blood samples were obtained on admission for the determination of the complete blood count, C-reactive protein (CRP), lactate dehydrogenase (LDH), prealbumin (PAB), immunoglobulins, subpopulations of T lymphocytes, specific antibody to MP, CT, LG, and cytokines including interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor alpha (TNF-) and interferon gamma (IFN-). Blood.