State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; School of Public Health, Shanxi Medical University, 56 Xinjiannanlu Street, Taiyuan, 030001, Shanxi, People's Republic of China.
State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Int J Infect Dis. 2022 Sep;122:867-873. doi: 10.1016/j.ijid.2022.07.054. Epub 2022 Jul 28.
Identifying pathogens in patients with pulmonary infection (PI) has always been a major challenge in medicine. Compared with sputum and throat swabs, bronchoalveolar lavage fluid (BALF) can better reflect the actual state of the lungs. However, there has not been a meta-analysis of the diagnostic efficacy of metagenomic next-generation sequencing (mNGS) in detecting pathogens in BALF from patients with PIs.
Data sources were PubMed, Web of Science, Embase, and the China National Knowledge Infrastructure. The pooled sensitivity and specificity were estimated using random-effects or fixed-effect models. Subgroup analysis was performed to reveal the effect of potential explanatory factors on the diagnostic performance measures.
The pooled sensitivity was 78% (95% confidence interval [CI]: 67-87%; I = 92%) and the pooled specificity was 77% (95% CI: 64-94%; I = 74%) for mNGS. Subgroup analyses for the sensitivity of mNGS revealed that patients with PIs who were severely ill or immunocompromised significantly affected heterogeneity (P < 0.001). The positive detection rate of mNGS for pathogens in BALF of severely or immunocompromised pulmonary-infected patients was 92% (95% CI: 78-100%).
mNGS has high diagnostic performance for BALF pathogens in patients with PIs, especially in critically ill or immunocompromised patients.
在肺部感染（PI）患者中鉴定病原体一直是医学上的一大挑战。与痰和咽拭子相比，支气管肺泡灌洗液（BALF）能更好地反映肺部的实际情况。然而，目前还没有关于宏基因组下一代测序（mNGS）检测 PI 患者 BALF 中病原体的诊断效能的荟萃分析。
检索PubMed、Web of Science、Embase 和中国知网数据库。采用随机效应或固定效应模型估计合并敏感性和特异性。进行亚组分析以揭示潜在解释因素对诊断性能指标的影响。
mNGS 的合并敏感性为 78%（95%置信区间：67-87%；I²=92%），特异性为 77%（95%置信区间：64-94%；I²=74%）。mNGS 敏感性的亚组分析表明，重症或免疫功能低下的 PI 患者显著影响异质性（P<0.001）。严重或免疫功能低下肺部感染患者的 BALF 中 mNGS 对病原体的阳性检出率为 92%（95%置信区间：78-100%）。
mNGS 对 PI 患者的 BALF 病原体具有较高的诊断性能，尤其是对重症或免疫功能低下的患者。
