Abstract Objective: To evaluate the discriminative ability of laboratory abnormalities between general mycoplasma pneumoniae pneumonia (GMPP) and refractory MPP (RMPP) in children. Methods: An electronic search in PubMed, Web of Science, Embase, and Cochrane Library was performed to identify studies reporting on laboratory abnormalities in children with GMPP and RMPP. Data were independently extracted by two reviewers. Meta-analyses within the random-effects model were used to synthesize data. Effect sizes were calculated as standardized mean differences (SMD) or weighted mean difference (WMD). The Newcastle-Ottawa Scale (NOS) was used to assess the methodologic quality of included studies. Results: Twenty-one articles (3,877 patients) comparing laboratory findings between patients with GMPP and RMPP were eligible for this meta-analysis. Patients with RMPP had significantly increased neutrophils, CD8+ lymphocytes, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), D-dimer, total IgA, total IgM, as well as decreased lymphocytes, hemoglobin, and albumin. Multiple inflammatory biomarkers (C-reactive protein [CRP], procalcitonin [PCT], erythrocyte sedimentation rate [ESR], ferritin, interleukin [IL]-6, IL-10, IL-17, IL-18, interferon-γ [IFN-γ], and tumor necrosis factor-α [TNF-α]) were also markedly elevated in RMPP patients. Conclusions: Elevated levels of CD8+ lymphocytes, LDH, AST, D-dimer, total IgA, total IgM, inflammatory biomarkers (CRP, PCT, ESR, ferritin, IL-6, IL-10, IL-17, IL-18, IFN-γ, and TNF-α), and lower lymphocytes, hemoglobin, and albumin are associated with RMPP and thus may be used as early identification or even prediction of RMPP in children. Keywords: Child; Refractory Mycoplasma pneumoniae pneumonia; clinical chemistry; meta-analysis