A Paired Comparison of Plasma and Bronchoalveolar Lavage Fluid for Metagenomic Next-Generation Sequencing in Critically Ill Patients with Suspected Severe Pneumonia.
A Paired Comparison of Plasma and Bronchoalveolar Lavage Fluid for Metagenomic Next-Generation Sequencing in Critically Ill Patients with Suspected Severe Pneumonia.
复制标题
血浆和支气管肺泡灌洗液对疑似重症肺炎危重患者进行宏基因组下一代测序的配对比较
DOI：
10.2147/idr.s374906
复制
发表时间：
2022
影响因子：
3.9
通讯作者：
中科院分区：
文献类型：
--
作者：
目的下一代血浆宏基因组测序（mNGS）已成为一种具有吸引力的微创病原体检测技术。然而，很少有研究表明重症肺炎患者需要同时使用血浆和支气管肺泡灌洗液（BALF） mNGS。患者与方法回顾性比较2019年4月至2020年12月疑似重症肺炎危重患者的BALF和血浆mNGS。以临床综合诊断为参考标准，比较BALF和血浆mNGS的诊断效能。结果本研究共纳入57例患者。血浆mNGS阳性患者标本采集时住院天数较短（4.5 vs 11, P = 0.028）， BALF培养阳性率较血浆mNGS阴性患者高（50% vs 22.9%, P = 0.033）。53例患者（93%）最终诊断为重症肺炎。BALF和血浆mNGS的敏感性差异有统计学意义（100% vs 42%, P < 0.001），诊断准确率分别为96%和46%。血浆mNGS阳性结果中病毒的比例高于BALF mNGS阳性结果（23% vs 11%, P = 0.173），差异无统计学意义。虽然血浆mNGS在11/53例患者中检测到额外的微生物，但仅在5/53（9%）患者中观察到有益效果。结论在本研究中，BALF和血浆样品同时进行mNGS的临床效果有限。对于疑似病毒感染的患者，血浆mNGS可作为补充检测。需要进一步的研究来确定血浆mNGS的最佳适应症。
Purpose Plasma metagenomic next-generation sequencing (mNGS) has emerged as an attractive and minimally invasive technique for pathogen detection. However, few studies have demonstrated the need for simultaneous plasma and bronchoalveolar lavage fluid (BALF) mNGS in patients with severe pneumonia. Patients and Methods This study retrospectively performed a paired comparison of BALF and plasma mNGS in critically ill patients with suspected severe pneumonia from April 2019 to December 2020. The diagnostic performance of BALF and plasma mNGS was compared using the clinical composite diagnosis as the reference standard. Results In total, 57 patients were included in this study. Patients with positive plasma mNGS had shorter hospital stay days at the time of specimen acquisition (4.5 vs 11, P = 0.028) and a higher positivity rate of BALF culture (50% vs 22.9%, P = 0.033) than patients with negative plasma mNGS. Fifty-three patients (93%) were finally diagnosed with severe pneumonia. Significant differences were observed in the sensitivity of BALF and plasma mNGS (100% vs 42%, P < 0.001), and the diagnostic accuracy was 96% and 46%, respectively. The proportion of virus in positive plasma mNGS results was higher than that in BALF mNGS (23% vs 11%, P = 0.173) without significant difference. Although plasma mNGS detected additional microorganisms in 11/53 patients, the beneficial effect was observed in only 5/53 (9%) patients. Conclusion In this study, the clinical effect of simultaneously conducting mNGS of BALF and plasma samples was found to be limited. For patients with the suspected virus infection, plasma mNGS may be a supplementary test. Further studies are needed to identify the optimal indications for plasma mNGS.