Department of Pulmonary and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Laboratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Cell Infect Microbiol. 2023 Jan 25;12:1023978. doi: 10.3389/fcimb.2022.1023978. eCollection 2022.
The aim of the current study was to investigate the clinical value of cellular analysis and metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) in differentiating pulmonary non-infectious and infectious diseases in immunocompetent patients.
The present retrospective study was conducted from December 2017 to March 2020, and included immunocompetent patients with suspected pulmonary infection. High-resolution computed tomography, total cell counts and classification of BALF, conventional microbiological tests (CMTs), laboratory tests and mNGS of BALF were performed. Patients were assigned to pulmonary non-infectious disease (PNID) and pulmonary infectious disease (PID) groups based on final diagnoses. PNID-predictive values were analyzed areas under receiver operating characteristic curves (AUCs). Optimal cutoffs were determined by maximizing the sum of sensitivity and specificity.
A total of 102 patients suspected of pulmonary infection were enrolled in the study, 23 (22.5%) with PNID and 79 (77.5%) with PID. The diagnostic efficiency of BALF mNGS for differentiating PID from PNID was better than that of CMTs. Neutrophil percentage (N%) and the ratio of neutrophils to lymphocytes (N/L) in BALF were significantly lower in the PNID group than in the PID group. The AUCs for distinguishing PNID and PID were 0.739 (95% confidence interval [CI] 0.636-0.825) for BALF N%, 0.727 (95% CI 0.624-0.815) for BALF N/L, and 0.799 (95% CI 0.702-0.876) for BALF mNGS, with respective cutoff values of 6.7%, 0.255, and negative. Joint models of BALF mNGS combined with BALF N/L or BALF N% increased the respective AUCs to 0.872 (95% CI 0.786-0.933) and 0.871 (95% CI 0.784-0.932), which were significantly higher than those for BALF mNGS, BALF N%, and BALF N/L alone.
BALF N% ≤ 6.7% or BALF N/L ≤ 0.255 combined with a negative BALF mNGS result can effectively distinguish PNID from PID in immunocompetent patients with suspected pulmonary infection. BALF mNGS outperforms CMTs for identifying pathogens in immunocompetent patients, and the combination of mNGS and CMTs may be a better diagnostic strategy.
本研究旨在探讨支气管肺泡灌洗液（BALF）细胞分析和宏基因组下一代测序（mNGS）在鉴别免疫功能正常患者肺部非传染性和传染性疾病中的临床价值。
本回顾性研究于 2017 年 12 月至 2020 年 3 月进行，纳入疑似肺部感染的免疫功能正常患者。进行高分辨率计算机断层扫描、BALF 总细胞计数和分类、常规微生物学检查（CMTs）、实验室检查和 mNGS。根据最终诊断将患者分为肺部非传染性疾病（PNID）和肺部传染性疾病（PID）组。通过受试者工作特征曲线（ROC）下面积（AUCs）分析 PNID 的预测值。通过最大化灵敏度和特异性的和来确定最佳截断值。
本研究共纳入 102 例疑似肺部感染患者，23 例（22.5%）为 PNID，79 例（77.5%）为 PID。BALF mNGS 鉴别 PID 和 PNID 的诊断效率优于 CMTs。PNID 组 BALF 中性粒细胞百分比（N%）和中性粒细胞与淋巴细胞比值（N/L）明显低于 PID 组。鉴别 PNID 和 PID 的 BALF N%、BALF N/L 和 BALF mNGS 的 AUC 分别为 0.739（95%CI 0.636-0.825）、0.727（95%CI 0.624-0.815）和 0.799（95%CI 0.702-0.876），截断值分别为 6.7%、0.255 和阴性。BALF mNGS 联合 BALF N/L 或 BALF N%的联合模型分别将各自的 AUC 提高至 0.872（95%CI 0.786-0.933）和 0.871（95%CI 0.784-0.932），明显高于 BALF mNGS、BALF N%和 BALF N/L 单独使用。
BALF N%≤6.7%或 BALF N/L≤0.255 联合 BALF mNGS 阴性结果可有效鉴别免疫功能正常患者疑似肺部感染的 PNID 和 PID。BALF mNGS 优于 CMTs 识别免疫功能正常患者的病原体，mNGS 和 CMTs 的联合可能是一种更好的诊断策略。
