Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Int J Med Sci. 2023 Oct 9;20(13):1698-1704. doi: 10.7150/ijms.89242. eCollection 2023.
Conventional methods are low in positive rates and time-consuming for ascites pathogen detection in patients with end-stage liver disease (ESLD). With many advantages, metagenomic next-generation sequencing (mNGS) may be a good alternative method. However, the related studies are still lacking. Ascites from 50 ESLD patients were sampled for pathogen detection using mNGS and conventional methods (culture and polymorphonuclear neutrophils detection) in this prospective observational study. Forty-two samples were detected positive using mNGS. 29 strains of bacteria, 11 strains of fungi, and 9 strains of viruses were detected. 46% of patients were detected to be co-infected with 2 or more pathogens by mNGS. Moreover, mNGS showed similar and high positive rates in ESLD patients with different clinical characteristics. Compared to conventional methods, mNGS had higher positivity rates (84% vs. 20%, <0.001), sensitivity (45.2% vs. 23.8%, =0.039), broader pathogen spectrum, shorter detection time (24 hours vs. 3-7 days), but lower specificity (25% vs 100%, = 0.010). Furthermore, compared to conventional methods, mNGS showed similar consistence with final diagnosis (42% vs. 36%, =0.539). mNGS may be a good supplement for conventional methods and helpful to early etiological diagnosis of peritonitis, and thus improve ESLD patients' survival.
传统方法检测终末期肝病（ESLD）患者腹水病原体的阳性率较低且耗时较长。宏基因组下一代测序（mNGS）具有许多优势，可能是一种很好的替代方法。然而，相关研究仍然缺乏。本前瞻性观察研究中，采用 mNGS 和传统方法（培养和多形核白细胞检测）对 50 例 ESLD 患者的腹水进行病原体检测。mNGS 检测到 42 份样本呈阳性。共检测到 29 株细菌、11 株真菌和 9 株病毒。mNGS 检测到 46%的患者合并 2 种或以上病原体感染。此外，mNGS 在不同临床特征的 ESLD 患者中显示出相似的高阳性率。与传统方法相比，mNGS 的阳性率更高（84%比 20%，<0.001），敏感性更高（45.2%比 23.8%，=0.039），病原体谱更广，检测时间更短（24 小时比 3-7 天），但特异性较低（25%比 100%，=0.010）。此外，与传统方法相比，mNGS 与最终诊断的一致性相似（42%比 36%，=0.539）。mNGS 可能是传统方法的良好补充，有助于早期病因诊断腹膜炎，从而提高 ESLD 患者的生存率。
