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Application of metagenomic next-generation sequencing for suspected infected pancreatic necrosis
Chiayen Lin1, Abdul Aziz F K Bonsu1, Jiarong Li1
1Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China.
Background:
Metagenomic next-generation sequencing (mNGS) is increasingly used for the clinical diagnosis of infectious diseases, but there is a paucity of data regarding the application of mNGS in the early diagnosis of infected pancreatic necrosis (IPN).
Objective:
To investigate the clinical application value of mNGS in the pathogenic diagnosis of IPN.
Methods:
Forty-two patients with suspected IPN were prospectively and consecutively enrolled from August 2019 to August 2021. Blood samples were collected for mNGS and microbial culture simultaneously during fever (T ≥ 38.5 °C). For patients who had indications of surgical interventions, peri-pancreatic specimens were collected for mNGS and microbial culture simultaneously during the first surgical intervention to confirm IPN. The clinical performance of mNGS and microbial culture were compared.
Results:
A total of 21 patients (50.0%) were confirmed to have IPN during hospitalization. The sensitivity of blood mNGS was significantly higher than blood culture (95.2% vs. 23.8%, P < 0.001) in diagnosing IPN. The negative predictive value of blood mNGS was 90.0%. The turnaround time of mNGS was significantly shorter than that of microbial culture [(37.70 ± 1.44) vs. (115.23 ± 8.79) h, P < 0.01] and the average costs of mNGS accounted for 1.7% of the average total cost of hospitalization. The survival analysis demonstrates that the positive blood mNGS result was not associated with increased mortality (P = 0.119).
Conclusions:
With more valuable diagnostic performance and shorter turnaround time, clinical mNGS represents a potential step forward in the early diagnosis of IPN.
Insights
Metagenomic next-generation sequencing (mNGS) offers a faster and more sensitive method for diagnosing infected pancreatic necrosis (IPN) compared to traditional cultures. This advanced technique shows promise for earlier and more accurate clinical detection of IPN.
Area of Science:
- Clinical microbiology
- Infectious disease diagnostics
- Genomic medicine
Background:
- Metagenomic next-generation sequencing (mNGS) is emerging in infectious disease diagnosis.
- Limited data exists on mNGS for early diagnosis of infected pancreatic necrosis (IPN).
Purpose of the Study:
- To evaluate the clinical utility of mNGS for pathogenic diagnosis of IPN.
- To compare mNGS performance against traditional microbial culture in suspected IPN cases.
Main Methods:
- Prospective enrollment of 42 patients with suspected IPN.
- Simultaneous collection of blood and peri-pancreatic samples for mNGS and microbial culture.
- Comparison of diagnostic sensitivity, specificity, and turnaround time between mNGS and culture.
Main Results:
- mNGS demonstrated significantly higher sensitivity (95.2%) than blood culture (23.8%) for IPN diagnosis (P < 0.001).
- mNGS offered a substantially shorter turnaround time (37.70 ± 1.44 h) compared to culture (115.23 ± 8.79 h) (P < 0.01).
- Positive mNGS results were not linked to increased patient mortality (P = 0.119).
Conclusions:
- Clinical mNGS shows superior diagnostic performance and speed for early IPN detection.
- mNGS represents a significant advancement for the early and accurate diagnosis of infected pancreatic necrosis.
- The study supports the integration of mNGS into clinical practice for IPN management.
