Etiological characteristics of severe pneumonia based on mNGS detection and its risk factors analysis
Objective To analyze etiological characteristics of severe pneumonia based on metagenomic next-generation sequencing(mNGS)of pulmonary alveolar lavage fluid of patients with severe pneumonia and predictive value.Methods A total of 159 patients with pneumonia were divided into severe group(55 cases)and non-severe group(104 cases)according to the diagnostic criteria of severe pneumonia.General clinical data,blood test data,mNGS detection of alveolar lavage fluid and sputum culture results of patients were collected after admission.Etiological characteristics were compared between two groups.Univariate analysis was used to screen the indicators with statistically significant differences between two groups of the patients.logistic regression analysis was performed to screen risk factors for severe pneumonia.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the predictive value of each indicator for severe pneumonia.Results When compared to sputum culture,pathogen detection rates of mNGS in both groups were significantly increased(P＜0.000 1).The total detection rate of mNGS in alveolar lavage fluid was higher in two groups than that in sputum culture(x2=318.001,P＜0.000 1).mNGS could detect chlamydia ptactaci,leptospirosis,Orientia tsutsugamushi and other atypical pathogens.In severe pneumonia group,mixed infections accounted for 60％of all detected pathogens,while mixed infections accounted for 29％of all detected pathogens in non-severe pneumonia group.Univariate analysis showed that there were statistically significant differences in gender,age,smoking,pathogen type,hemoglobin,lymphocyte percentage,neutrophil percentage,red blood cell distribution width(RDW),procalcitonin(PCT),C-reactive protein,albumin,and D-dimer between severe and non-severe groups(P＜0.05).Multivariate logistic regression analysis showed that pathogen type,RDW,and PCT were independent risk factors for severe pneumonia(P＜0.05).When predicting with a single indicator,PCT had the highest AUC of 0.856,with a sensitivity of 87.27％and specificity of 66.35％.When predicting with the combination,the AUC of combined PCT and RDW was 0.818,with a sensitivity of 76.36％and specificity of 76.92％.Conclusion mNGS technology has a high positive rate for pathogen detection and a special value for atypical pathogen detection.Severe pneumonia group is more prone to mixed pathogen infections.PCT alone or in combination with RDW detection is a good indicator for predicting severe pneumonia.
severe pneumoniametagenomic next-generation sequencingetiologyerythrocyte widthprocalcitonintype of infection
万方数据
维普
