Metagenomic next-generation sequencing for the clinical diagnosis and prognosis of acute respiratory distress syndrome caused by severe pneumonia: a retrospective study.

Peng Zhang,Chaoliang Li,Yantang Chen,Yanming Huang,Yan Chen,Shengming Liu,Shuyun Li,Xin Zhang,Jie Ma,Shuang Zhang,Weihao Zheng

doi:10.7717/peerj.9623

Peng Zhang, Chaoliang Li + Show 9 more

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https://doi.org/10.7717/peerj.9623

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Abstract

BackgroundMetagenome next-generation sequencing (mNGS) is a valuable diagnostic tool that can be used for the identification of early pathogens of acute respiratory distress syndrome (ARDS) in severe pneumonia. Little is known about the use of this technology in clinical application and the evaluation of the prognostic value of ARDS.MethodsWe performed a retrospective cohort study of patients with ARDS caused by severe pneumonia. Samples were collected from patients in the intensive care unit (ICU) of Jiangmen Central Hospital from January 2018 to August 2019. The no-next generation sequencing (NGS) group was composed of patients given conventional microbiological tests to examine sputum, blood, or bronchoalveolar lavage fluid. The NGS group was composed of patients tested using mNGS and conventional microbiological tests. We evaluated the etiological diagnostic effect and clinical prognostic value of mNGS in patients with ARDS caused by severe pneumonia.ResultsThe overall positive rate (91.1%) detected by the mNGS method was significantly higher than that of the culture method (62.2%, P = 0.001), and antibody plus polymerase chain reaction (28.9%, P < 0.001). Following adjustment of the treatment plan based on microbial testing results, the Acute Physiology and Chronic Health Evaluation-II (APACHE II) score of the NGS group was lower than that of the no-NGS group 7 days after treatment (P < 0.05). The 28-day mortality rate of the NGS group was significantly lower than that of the no-NGS group (P < 0.05). Longer ICU stay, higher APACHE II score and sequential organ failure assessment score were risk factors for the death of ARDS, and adjusting the medication regimen based on mNGS results was a protective factor. The detection of mNGS can significantly shorten the ICU stay of immunosuppressed patients (P < 0.01), shorten the ventilation time (P < 0.01), and reduce the ICU hospitalization cost (P < 0.05).ConclusionsMetagenome next-generation sequencing is a valuable tool to determine the etiological value of ARDS caused by severe pneumonia to improve diagnostic accuracy and prognosis for this disease. For immunosuppressed patients, mNGS technology can be used in the early stage to provide more diagnostic evidence and guide medications.

Highlights

Acute respiratory distress syndrome (ARDS) is typically caused by infections, such as pneumonia (Saguil & Fargo, 2012)
Metagenome next-generation sequencing is a valuable diagnostic tool that can be used for the identification of early pathogens of acute respiratory distress syndrome (ARDS) in severe pneumonia
We evaluated the etiological diagnostic effect and clinical prognostic value of Metagenome next-generation sequencing (mNGS) in patients with ARDS caused by severe pneumonia

Summary

INTRODUCTION

Acute respiratory distress syndrome (ARDS) is typically caused by infections, such as pneumonia (Saguil & Fargo, 2012). Metagenome next-generation sequencing (mNGS) was first used to diagnose a central nervous system (CNS) infection of Leptospira in 2014 (Wilson et al, 2014) This emerging diagnostic technology can quickly detect all nucleic acids in specimens of different sample types in one test, including blood, respiratory tract, CNS, and focal tissue (Guan et al, 2016; Guo et al, 2019; Long et al, 2016; Miao et al, 2018). This study summarizes clinical information via retrospective analysis, and evaluates the clinical prognosis of ARDS by mNGS technology application

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