General Intensive Care Unit, Zhengzhou Key Laboratory of Sepsis, Henan Key Laboratory of Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Cell Infect Microbiol. 2022 Jul 13;12:905132. doi: 10.3389/fcimb.2022.905132. eCollection 2022.
To analyze the clinical application and related influencing factors of metagenomic next-generation sequencing (mNGS) in patients with sepsis in intensive care unit (ICU).
The study included 124 patients with severe sepsis admitted to the ICU in the First Affiliated Hospital of Zhengzhou University from June 2020 to September 2021. Two experienced clinicians took blood mNGS and routine blood cultures of patients meeting the sepsis diagnostic criteria within 24 hours after sepsis was considered, and collection the general clinical data.
mNGS positive rate was higher than traditional blood culture (67.74% vs. 19.35%). APACHE II score [odds ratio ()=1.096], immune-related diseases (=6.544), and hypertension (=2.819) were considered as positive independent factors for mNGS or culture-positive. The sequence number of microorganisms and pathogen detection (mNGS) type had no effect on prognosis. Age (=1.016), female (=5.963), myoglobin (=1.005), and positive virus result (=8.531) were independent risk factors of sepsis mortality. Adjusting antibiotics according to mNGS results, there was no statistical difference in the prognosis of patients with sepsis.
mNGS has the advantages of rapid and high positive rate in the detection of pathogens in patients with severe sepsis. Patients with high APACHE II score, immune-related diseases, and hypertension are more likely to obtain positive mNGS results. The effect of adjusting antibiotics according to mNGS results on the prognosis of sepsis needs to be further evaluated.
分析宏基因组下一代测序（mNGS）在重症监护病房（ICU）脓毒症患者中的临床应用及相关影响因素。
本研究纳入 2020 年 6 月至 2021 年 9 月郑州大学第一附属医院 ICU 收治的 124 例严重脓毒症患者。两名经验丰富的临床医生在考虑脓毒症后 24 小时内对符合脓毒症诊断标准的患者进行血 mNGS 和常规血培养，并采集一般临床数据。
mNGS 阳性率高于传统血培养（67.74% vs. 19.35%）。APACHE II 评分[比值比（OR）=1.096]、免疫相关疾病（OR=6.544）和高血压（OR=2.819）被认为是 mNGS 或培养阳性的独立阳性因素。微生物序列数和病原体检测（mNGS）类型对预后无影响。年龄（OR=1.016）、女性（OR=5.963）、肌红蛋白（OR=1.005）和阳性病毒结果（OR=8.531）是脓毒症死亡的独立危险因素。根据 mNGS 结果调整抗生素，脓毒症患者的预后无统计学差异。
mNGS 在检测严重脓毒症患者病原体方面具有快速、阳性率高的优点。APACHE II 评分高、免疫相关疾病和高血压的患者更有可能获得 mNGS 阳性结果。根据 mNGS 结果调整抗生素对脓毒症预后的影响需要进一步评估。
