Application value of metagenomic next-generation sequencing in pathogenic diagnosis of sus-pected infected severe acute pancreatitis
Objective To investigate the application value of metagenomic next-genera-tion sequencing(mNGS)in pathogenic diagnosis of suspected infected severe acute pancreatitis(SAP).Methods The prospective study was conducted.The clinical data of 25 patients with suspected infected SAP who were admitted to the Xiangya Hospital of Central South University from May to September 2023 were collected.Upper limb venous blood samples of all the patients were collected for both of mNGS and routine pathogen microbial culture.Observation indicators:(1)grouping situations of the enrolled patients;(2)comparison of the diagnostic efficiency of mNGS and routine pathogen microbial culture;(3)results of peripheral blood pathogen microbial testing and peri-pancreatic effusion microbial culture;(4)testing time and cost.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the independent sample t test.Measurement data with skewed distribution were represented as M(Q1,Q3).Count data were expressed as absolute numbers or percentages,and comparison between groups was conducted using the chi-square test.Results(1)Grouping situations of the enrolled patients.A total of 25 patients were selected for eligibility.There were 18 males and 7 females,aged 48(40,59)years.The duration of hospital stay of 25 patients was 30(20,50)days.The etiologies of 25 patients included 14 cases of hyperlipidemic pancreatitis,8 cases of biliary pancreatitis,1 case of alcohol-induced acute pancreatitis,and 2 cases of pancreatitis caused by other causes.Of the 25 patients,there were 17 cases with infected pancreatic necrosis(IPN)including 7 cases of death,and 8 cases with sterile pancreatic necrosis including no death.(2)Comparison of the diagnostic efficiency of mNGS and routine pathogen microbial culture.The positive rates of mNGS and routine pathogen microbial culture in diagnosis of suspected infected SAP were 72.0％(18/25)and 32.0％(8/25),respectively,showing a significant difference between them(x2=8.01,P＜0.05).The sensitivity and negative predic-tive value of mNGS and routine pathogen microbial culture in diagnosis of IPN were 94.1％(16/17),35.3％(6/17)and 85.7％(6/7),35.3％(6/17),showing significant differences between them(x2=12.88,5.04,P＜0.05).The specificity and positive predictive value of mNGS and routine pathogen microbial culture in diagnosis of IPN were 75.0％(6/8),75.0％(6/8)and 88.9％(16/18),75.0％(6/8),showing no significant difference between them(x2=0,0.82,P＞0.05).(3)Results of peripheral blood pathogen microbial testing and peripancreatic effusion microbial culture.Of the 17 patients with IPN,36 strains of pathogenic bacteria were detected by mNGS,and 6 strains were detected by routine pathogen microbial culture.There were 16 of 17 patients with IPN showing positive mNGS pathogenic testing,of which 13 cases were consistent with the pathogenic testing results of peri-pancreatic effusion microbial culture,showing a consistency rate of 76.5％(13/17).There were 6 pati-ents with IPN showing positive routine pathogen microbial culture,with a consistency rate of 35.3％(6/17)to peripancreatic effusion microbial culture.(4)Testing time and cost.Testing time of mNGS and routine pathogen microbial culture were(43±17)hours and(111±36)hours,showing a signifi-cant difference between them(t=9.31,P＜0.05).Testing cost of mNGS was(2 267±0)yuan/case,accoun-ting for 1.7％of the hospitalization expenses of(133 759±120 744)yuan/case.Testing cost of routine pathogen microbial culture was(240±0)yuan/case,accounting of 0.2％of the hospitalization expenses.Conclusion mNGS has important value for early pathogenic diagnosis of suspected infected SAP,and has a high timeliness.
Severe acute pancreatitisInfected pancreatic necrosisMetagenomic next-generation sequencingDiagnosisTherapy
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