Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China.
Pancreatology. 2022 Nov;22(7):864-870. doi: 10.1016/j.pan.2022.07.006. Epub 2022 Jul 16.
Metagenomic next-generation sequencing (mNGS) is increasingly used for the clinical diagnosis of infectious diseases, but there is a paucity of data regarding the application of mNGS in the early diagnosis of infected pancreatic necrosis (IPN).
To investigate the clinical application value of mNGS in the pathogenic diagnosis of IPN.
Forty-two patients with suspected IPN were prospectively and consecutively enrolled from August 2019 to August 2021. Blood samples were collected for mNGS and microbial culture simultaneously during fever (T ≥ 38.5 °C). For patients who had indications of surgical interventions, peri-pancreatic specimens were collected for mNGS and microbial culture simultaneously during the first surgical intervention to confirm IPN. The clinical performance of mNGS and microbial culture were compared.
A total of 21 patients (50.0%) were confirmed to have IPN during hospitalization. The sensitivity of blood mNGS was significantly higher than blood culture (95.2% vs. 23.8%, P < 0.001) in diagnosing IPN. The negative predictive value of blood mNGS was 90.0%. The turnaround time of mNGS was significantly shorter than that of microbial culture [(37.70 ± 1.44) vs. (115.23 ± 8.79) h, P < 0.01] and the average costs of mNGS accounted for 1.7% of the average total cost of hospitalization. The survival analysis demonstrates that the positive blood mNGS result was not associated with increased mortality (P = 0.119).
With more valuable diagnostic performance and shorter turnaround time, clinical mNGS represents a potential step forward in the early diagnosis of IPN.
宏基因组下一代测序（mNGS）越来越多地用于临床传染病诊断，但关于 mNGS 在感染性胰腺坏死（IPN）早期诊断中的应用数据很少。
探讨 mNGS 在 IPN 病原诊断中的临床应用价值。
前瞻性连续纳入 2019 年 8 月至 2021 年 8 月期间 42 例疑似 IPN 的患者。发热时（T≥38.5℃）同时采集血样进行 mNGS 和微生物培养。对于有手术干预指征的患者，首次手术干预时同时采集胰周标本进行 mNGS 和微生物培养以明确 IPN。比较 mNGS 和微生物培养的临床性能。
住院期间共有 21 例（50.0%）患者被确诊为 IPN。血 mNGS 诊断 IPN 的灵敏度明显高于血培养（95.2%比 23.8%，P<0.001）。血 mNGS 的阴性预测值为 90.0%。mNGS 的检测周转时间明显短于微生物培养的时间[（37.70±1.44）比（115.23±8.79）h，P<0.01]，mNGS 的平均费用占住院总费用的 1.7%。生存分析表明，阳性血 mNGS 结果与死亡率增加无关（P=0.119）。
mNGS 具有更有价值的诊断性能和更短的检测周转时间，代表了 IPN 早期诊断的一个潜在进展。
