Objective To evaluate the clinical characteristics and related risk factors of invasive fungal disease(IFD)in patientswith blood diseases diagnosed by high-throughput metagenomic sequencing(mNGS).Methods From January 2022 to January 2023,70 hospitalized patients with blood diseases who were suspected of infection with IFD underwent mNGS and fungal pathogen detection.The clinical characteristics and laboratory data of 32 fungal infected individuals(IFD group)and 38 non IFD groups were compared.Results In the IFD group,15 cases(47％)of Candida,6 cases(19％)of Aspergillus,4 cases(12.5％)of Rhizopus,4 cases(12.5％)of Spores,and 3 other cases(9％)were detected by mNGS.Out of 36 blood samples,11(30.6％)were positive by mNGS;However,there were only 3 cases(8.3％)of fungal microbial culture,with a significant difference in positive detection rate(P=0.017).Using traditional fungal culture results as the"gold standard",the sensitivity,specificity,positive predictive value,and negative predictive value of mNGS for evaluating fungal infection in hematological patients were calculated,and the results were 100％(10/10),63.3％(38/60),31.3％(10/32),and 100％(38/38),respectively.After multiple logistic regression analysis,the risk factors associated with IFD were:CD4+cell count below 400 cells/μL[OR 7.43,95％CI 7.43(2.46-22.44),P＜0.001],increased level of C-reactive protein[OR 3.71,95％CI 3.71(1.33-10.32),P=0.01],IL-6[OR 6.5,95％CI6.50(2.27-18.62),P＜0.001]and IL-10[OR 3.03,95％CI 3.03(1.03-8.94),P=0.041],hypoalbuminemia[OR 7.04,95％CI 7.04(1.40-35.56),P=0.025]and sustained neutropenia lasting for more than 10 days[OR 3.03,95％CI 3.03(1.03-8.94),P=0.002].Conclusion mNGS has high sensitivity in detecting IFD in patients with hematological diseases.CD4+cell count below 400/μL,increased level of C-reactive protein,IL-6,and IL-10,hypoalbuminemia,and neutropenia lasting for more than 10 days are independent risk factors for IFD in patients with hematological diseases.
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