Serum HMGB3 and PCSK9 Levels as Predictors of Early Treatment Response in Pediatric Mycoplasma pneumoniae Pneumonia: A Single-Center Prospective Cohort Study.
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OBJECTIVE: To investigate the predictive value of serum high mobility group box 3 (HMGB3) and proprotein convertase subtilisin/kexin type 9 (PCSK9) levels for poor early treatment response in pediatric Mycoplasma pneumoniae pneumonia (MPP). METHODS: A total of 400 pediatric patients with Mycoplasma pneumoniae pneumonia (MPP) and 178 healthy controls were recruited for this single-center prospective cohort study conducted between January 2022 and January 2025. All patients received standardized azithromycin sequential therapy. Based on the criteria for early treatment response at 7 days post-treatment, patients were categorized into the good early treatment response group (n=321) and the poor early treatment response group (n=79). Multivariable logistic regression was performed to identify independent predictors, receiver operating characteristic (ROC) curve analysis was used to evaluate predictive performance, and Spearman correlation analysis was conducted to assess correlations with inflammatory markers. RESULTS: Serum HMGB3 and PCSK9 levels in children with MPP were significantly higher than those in the healthy control group, and were significantly higher in the poor early treatment response group than in the good early treatment response group (all P<0.05). Multivariable logistic regression analysis showed that HMGB3 (odds ratio [OR]=2.310, P<0.001) and PCSK9 (OR=1.518, P=0.027) were independent predictors of poor early treatment response in MPP. ROC analysis revealed that the areas under the curve (AUC) for HMGB3 and PCSK9 alone were 0.766 and 0.758, respectively, and the AUC for combined detection increased to 0.840. HMGB3 and PCSK9 were weakly positively correlated with interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α). CONCLUSION: Serum HMGB3 and PCSK9 are independent predictors of poor early treatment response in children with MPP. Combined detection demonstrates superior predictive performance compared with individual markers and may serve as a reference for short-term risk assessment.