Xu Xiangzhi, Zheng Yafeng, Zhang Xiaojing, Zhang Chenmei, Gai Wei, Yang Zihao
Department of Pediatric Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
WillingMed Technology (Beijing) Co., Ltd, Beijing, People's Republic of China.
Infect Drug Resist. 2024 Aug 16;17:3579-3591. doi: 10.2147/IDR.S472129. eCollection 2024.
Infections cause high rates of illness and death in children worldwide. However, studies on the clinical value of metagenomic next-generation sequencing (mNGS) for immunocompromised children are still limited.
From June 2021 to December 2023, 119 samples were collected at Pediatric Intensive Care Unit (PICU) of a single-center pediatric hospital and classified into two groups based on their immune states. We compared the diagnostic performance of mNGS and conventional microbiological test (CMT) for pathogen identification, and assessed the clinical impacts of mNGS.
Among the 119 samples, 48 (40.34%) belonged to the immunocompromised children. mNGS had a higher positivity rate than CMT (76.47% vs 55.46%, = 0.0006). The positive percent agreement (PPA) of mNGS for immunocompromised children was higher compared to immunocompetent children (95.24% vs 77.78%). The most common pathogens for immunocompromised patients were gram-negative bacteria and herpesvirus. However, immunocompetent children showed a higher detection rate for gram-positive bacteria and respiratory viruses. Furthermore, the proportions of the positive impact of mNGS results were significantly higher in immunocompromised patients compared to immunocompetent patients for both diagnosis (91.67% vs 57.75%) and treatment (95.83% vs 64.79%) ( < 0.0001). Immunocompromised state, length of hospital stays, times stay in ICU, Pediatric Risk of Mortality (PRISM) score, neutrophil percentage (NEUT%) and the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) were considered independent factors for poor prognosis in critically ill pediatric patients.
In patients from PICU, mNGS had a greater clinical significance in immunocompromised children compared to immunocompetent children. mNGS technology is an important auxiliary method for achieving accurate diagnosis and treatment of critically ill pediatric patients.
感染在全球儿童中导致了高发病率和高死亡率。然而，关于宏基因组下一代测序（mNGS）对免疫功能低下儿童的临床价值的研究仍然有限。
2021年6月至2023年12月，在一家单中心儿科医院的儿科重症监护病房（PICU）收集了119份样本，并根据其免疫状态分为两组。我们比较了mNGS和传统微生物检测（CMT）在病原体鉴定方面的诊断性能，并评估了mNGS的临床影响。
在119份样本中，48份（40.34%）属于免疫功能低下儿童。mNGS的阳性率高于CMT（76.47%对55.46%，P = 0.0006）。mNGS对免疫功能低下儿童的阳性百分一致性（PPA）高于免疫功能正常儿童（95.24%对77.78%）。免疫功能低下患者最常见的病原体是革兰氏阴性菌和疱疹病毒。然而，免疫功能正常儿童对革兰氏阳性菌和呼吸道病毒的检出率更高。此外，mNGS结果对免疫功能低下患者在诊断（91.67%对57.75%）和治疗（95.83%对64.79%）方面的积极影响比例均显著高于免疫功能正常患者（P < 0.0001）。免疫功能低下状态、住院时间、入住ICU时间、儿童死亡风险（PRISM）评分、中性粒细胞百分比（NEUT%）以及动脉血氧分压与吸入氧分数比（PaO2/FiO2）被认为是危重症儿科患者预后不良的独立因素。
在PICU患者中，与免疫功能正常儿童相比，mNGS对免疫功能低下儿童具有更大的临床意义。mNGS技术是实现危重症儿科患者准确诊断和治疗的重要辅助方法。
