Abstract
Objectives
To evaluate the relation between metagenomic next-generation sequencing (mNGS) and the prognosis of patients with infectious diseases undergoing mechanical ventilation in the intensive care unit (ICU).
Methods
This is a single-center observational study, comparing nonrandomly assigned diagnostic approaches. We analyzed the medical records of 228 patients with suspected infectious diseases undergoing mechanical ventilation in the ICU from March 2018 to May 2020. The concordance of pathogen results was also assessed for the results of mNGS, culture, and polymerase chain reaction assays.
Results
The 28-day mortality of the patients in the mNGS group was lower after the baseline difference correction (19.23% (20/104) vs 29.03% (36/124) , P = 0.039). Subgroup analysis showed that mNGS assay was associated with improved 28-day mortality of patients who are not immunosuppressed (14.06% vs 29.82%, P = 0.018). Not performing mNGS assay, higher acute physiology and chronic health evaluation II score, and hypertension are independent risk factors for 28-day mortality. The mNGS assay presented an advantage in pathogen positivity (69.8% double-positive and 25.0% mNGS-positive only), and the concordance between these two assays was 79.0%.
Conclusion
mNGS survey may be associated with a better prognosis by reducing 28-day mortality of patients with infectious diseases on mechanical ventilation in the ICU. This technique presented an advantage in pathogen positivity over traditional methods.
【저자키워드】 Mortality, Prognosis, intensive care unit, Metagenomic next-generation sequencing, severe pneumonia, Pathogens diagnosis, 【초록키워드】 intensive care, mechanical ventilation, diagnostic, 28-day mortality, Infectious disease, hypertension, ICU, Health, Concordance, Culture, pathogen, Next-generation sequencing, Patient, Analysis, Immunosuppressed, medical record, traditional methods, approaches, single-center, independent risk factor, objective, polymerase chain, Result, analyzed, evaluate, the patient, assays, reducing, assigned, prognosis of patient, baseline, metagenomic, on mechanical ventilation, 【제목키워드】 intensive care, mechanical ventilation, Infectious disease, Next-generation sequencing, receiving, metagenomic,