Objective: This study aims to elucidate the clinical manifestations and determinants of severe mycoplasma pneumonia in the pediatric population, thereby facilitating timely intervention.Methods: Collected the clinical data of 97 children with Mycoplasma pneumoniae[?] pneumonia (MPP) admitted to the Department of Pediatrics at Zhengzhou First People"s Hospital between January 2023 and October 2024. Based on the severity of their condition, they were divided into a mild group and a severe group. The general situation, clinical characteristics and related laboratory test results between the two groups were analyzed. The comparison between the two groups was performed using two independent sample t-test, Mann-Whitney U test and ?2 test. After multi-factor logistic regression analysis, the subjects" working characteristic curve (ROC) was drawn to explore the risk factors for severe MPP.Results: There was no significant difference in age and gender between the two groups of children (P>0.05). The fever duration in the severe group was significantly longer (P<0.05), indicating a statistically significant difference. Compared with the hospital stay in the two groups, there was no statistically significant difference (P>0.05). The proportion of neutrophils, CRP, D-dimer, LDH, IL-6, and interferon-γ in the peripheral blood of children in the severe group was significantly higher than that in the mild group (P<0.05), while the ALB level in the former was significantly lower than that in the latter (P<0.05). A multi-factor logistic regression analysis was further performed, showing that the number of fever days, CRP, LDH, and ALB were identified as independent risk factors for severe MPP (all P < 0.05). The ROC curve was drawn showing that when the fever days >4.5d, CRP >22.9mg/L, LDH >338U/L, and ALB <40.9g/L, the sensitivity and specificity of predicting the occurrence of severe MPP were: 95.7% and 39.2%, 69.6% and 88.2%, 50% and 92.2%, 41.3% and 86.3%, respectively, and the area under the curve was: 0.763, 0.863, 0.664, and 0.623; the sensitivity of the above indicators for joint detection was 89.1%, the specificity was 86.3%, and the area under the curve reached 0.932. P is all <0.05).Conclusion: Children with SMPP have a long duration of fever and significantly increased inflammation indicators. The number of fever days, CRP, LDH, and ALB are independent risk factors for the occurrence of SMPP. When CRP is > 22.9 mg/L and LDH > 338U, it helps to identify SMPP early. The fever time and ALB level are not effective in clinical diagnosis of SMPP and are not enough to be used as predictors alone. Multi-index combined detection has important clinical significance for the diagnosis of SMPP.