Liu Chengxi, Song Xiao, Liu Jihai, Zong Liang, Xu Tao, Han Xu, Li Fan, Li Bo, Zhu Huadong, Shi Di
Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, NO. 1 Shuai Fu Yuan,Dongcheng District, Beijing, 100730, China.
Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Bejing, China.
Crit Care. 2025 Feb 3;29(1):55. doi: 10.1186/s13054-025-05288-9.
Pathogen identification is essential in sepsis and septic shock. Metagenomic next-generation sequencing (mNGS) is a novel pathogen detection method with several advantages over traditional tests. However, the consistency between mNGS and traditional pathogen tests requires further investigation.
We aimed to assess the consistency between mNGS and traditional pathogen tests and to identify the factors influencing this consistency.
This systematic review and meta-analysis involved a comprehensive search of mNGS and traditional pathogen tests in PubMed, Embase, Scopus, Web of Science, and the Cochrane Library. Data from included studies were extracted, and kappa consistency between mNGS and traditional tests was calculated. Study quality was evaluated using the QUADAS-2 tool.
The search identified 415 studies, of which 27 were included in the analysis, involving 4112 individuals. Meta-analysis showed a pooled consistency of 0.319 ± 0.013 (p < 0.001), indicating a moderate relationship. In terms of sample type, cerebrospinal fluid showed the highest pooled kappa consistency at 0.500 ± 0.029 (p < 0.001). Immunocompromised patients had a lower pooled kappa consistency of 0.294 ± 0.014 (p < 0.001) compared to 0.321 ± 0.028 (p < 0.001) in immunocompetent patients. Positive percent agreement of mNGS was 83.63% over traditional microbiological test, and negative percent agreement was 54.59%.
This review demonstrates a moderate relationship between mNGS and traditional pathogen tests, indicating a complex relationship between these two methods. Sterile samples show higher consistency than non-sterile samples. Immune function deficiency may reduce the consistency between mNGS and traditional tests. Further research is needed on the use of mNGS in sepsis and septic shock.
病原体鉴定在脓毒症和感染性休克中至关重要。宏基因组下一代测序（mNGS）是一种新型病原体检测方法，与传统检测方法相比具有多个优势。然而，mNGS与传统病原体检测之间的一致性需要进一步研究。
我们旨在评估mNGS与传统病原体检测之间的一致性，并确定影响这种一致性的因素。
这项系统评价和荟萃分析全面检索了PubMed、Embase、Scopus、Web of Science和Cochrane图书馆中关于mNGS和传统病原体检测的研究。提取纳入研究的数据，并计算mNGS与传统检测之间的kappa一致性。使用QUADAS - 2工具评估研究质量。
检索到415项研究，其中27项纳入分析，涉及4112名个体。荟萃分析显示合并一致性为0.319±0.013（p < 0.001），表明两者关系中等。在样本类型方面，脑脊液的合并kappa一致性最高，为0.500±0.029（p < 0.001）。免疫功能低下患者的合并kappa一致性较低，为0.294±0.014（p < 0.001），而免疫功能正常患者为0.321±0.028（p < 0.001）。mNGS的阳性百分比一致性比传统微生物检测高83.63%，阴性百分比一致性为54.59%。
本综述表明mNGS与传统病原体检测之间存在中等关系，这表明这两种方法之间的关系较为复杂。无菌样本的一致性高于非无菌样本。免疫功能缺陷可能会降低mNGS与传统检测之间的一致性。关于mNGS在脓毒症和感染性休克中的应用，还需要进一步研究。
