宏基因组二代测序诊断的卡氏肺孢子菌肺炎患者院内死亡的危险因素。
Risk factors of in-hospital mortality in patients with pneumocystis pneumonia diagnosed by metagenomics next-generation sequencing.
机构信息
Department of Pulmonary, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Cardiology, Cardiovascular Center, Henan Key Laboratory of Hereditary Cardiovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
出版信息
Front Cell Infect Microbiol. 2022 Sep 26;12:994175. doi: 10.3389/fcimb.2022.994175. eCollection 2022.
OBJECTIVES
The metagenomic next-generation sequencing (mNGS) test is useful for rapid and accurate detection and identification of pathogenic microorganisms. The aim of the present study was to investigate the factors associated with in-hospital mortality in pneumocystis pneumonia (PCP) patients with mNGS-assisted diagnosis.
METHODS
Our study enrolled 154 patients with mNGS-positive PCP from August 2018 to February 2022 at the First Affiliated Hospital of Zhengzhou University respectively. Patients were divided into the survivor group (n=98) and the death group (n=56) according to whether in-hospital death occurred. Baseline characteristics, patients' pre-hospital symptoms and patients' CT imaging performance during hospitalization were carefully compared between the two groups. Risk factors for the occurrence of in-hospital death were sought by selecting indicators that were significantly different between the two groups for modelling and performing multiple logistic regression analysis.
RESULTS
Compared with the in-hospital death patients, the survivors were younger and had higher levels of albumin (ALB) (age: 50.29 ± 14.63 years vs 59.39 ± 12.27 years, p<0.001; ALB: 32.24 ± 5.62 g/L vs 29.34 ± 5.42g/L, p=0.002; respectively), while the levels of lactate dehydrogenase (LDH) and C-reactive protein CRP were lower (LDH: 574.67 ± 421.24 U/L vs 960.80 ± 714.94 U/L, p=0.001; CRP: 54.97 ± 55.92 mg/L vs80.45 ± 73.26 mg/L, 0.018; respectively). Multiple logistic regression analysis revealed that age, the baseline LDH and CRP levels were all positively associated with high in-hospital mortality [age: OR(95%CI): 1.115 (1.062-1.172), p<0.001; LDH: OR(95%CI): 1.002 (1.001-1.003), p<0.001; CRP: OR(95%CI): 1.008 (1.000-1.017), p=0.045; respectively] while the platelet counts was negatively associated with it [OR(95%CI): 0.986 (0.979-0.992), p<0.001].
CONCLUSIONS
Old age, high baseline levels of LDH and CRP and low platelet counts were risk factors of the in-hospital mortality in mNGS positive PCP patients.
目的
宏基因组下一代测序（mNGS）检测可用于快速准确地检测和鉴定致病微生物。本研究旨在探讨 mNGS 辅助诊断的肺孢子菌肺炎（PCP）患者住院病死率的相关因素。
方法
本研究纳入了 2018 年 8 月至 2022 年 2 月期间在郑州大学第一附属医院接受 mNGS 阳性 PCP 治疗的 154 例患者。根据住院期间是否死亡，将患者分为存活组（n=98）和死亡组（n=56）。仔细比较两组患者的基线特征、患者入院前症状和住院期间的 CT 影像学表现。对两组间存在统计学差异的指标进行建模，并进行多因素逻辑回归分析，以寻找导致住院死亡的危险因素。
结果
与住院死亡患者相比，存活患者年龄较小，白蛋白（ALB）水平较高（年龄：50.29±14.63 岁 vs 59.39±12.27 岁，p<0.001；ALB：32.24±5.62g/L vs 29.34±5.42g/L，p=0.002；分别），而乳酸脱氢酶（LDH）和 C 反应蛋白（CRP）水平较低（LDH：574.67±421.24 U/L vs 960.80±714.94 U/L，p=0.001；CRP：54.97±55.92mg/L vs 80.45±73.26mg/L，p=0.018；分别）。多因素逻辑回归分析显示，年龄、基线 LDH 和 CRP 水平均与高住院病死率相关[年龄：OR（95%CI）：1.115（1.062-1.172），p<0.001；LDH：OR（95%CI）：1.002（1.001-1.003），p<0.001；CRP：OR（95%CI）：1.008（1.000-1.017），p=0.045；分别]，而血小板计数则与之呈负相关[OR（95%CI）：0.986（0.979-0.992），p<0.001]。
结论
高龄、基线 LDH 和 CRP 水平升高以及血小板计数降低是 mNGS 阳性 PCP 患者住院病死率的危险因素。
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