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Published on: November 10, 2023
Cumulative respiratory pathogen detection burden by multiplex PCR is associated with mortality in a TB-enriched ICU
Jurong Yan1, Qian He1, Lihui Zhao1
1Department of Clinical Laboratory, Wuhan Pulmonary Hospital, Wuhan, China.
Microbiology Spectrum
|July 22, 2026
Summary
In critically ill patients, a higher number of pathogens detected by multiplex PCR in respiratory samples is linked to increased short-term mortality. This pathogen detection burden may serve as an exploratory risk signal in intensive care units.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Molecular Diagnostics
Background:
- Multiplex polymerase chain reaction (mPCR) is increasingly used in intensive care units (ICUs) for respiratory pathogen detection.
- The prognostic value of cumulative pathogen detection burden in critically ill patients with suspected tuberculosis (TB) or complex respiratory infections is unclear.
Purpose of the Study:
- To evaluate the association between cumulative pathogen detection count and mortality in ICU patients with suspected TB or complex respiratory infections.
- To determine if pathogen detection burden can serve as a risk-stratification signal beyond simple pathogen identification.
Main Methods:
- Retrospective study of 130 ICU patients with severe respiratory symptoms.
- Bronchoalveolar lavage fluid (BALF) analyzed by mPCR within 48 hours of admission.
- Multivariable logistic and Cox regression models used to assess the association between total pathogen detection count and mortality, adjusted for clinical factors.
Main Results:
- The mPCR positivity rate was 93.8%, with 46.9% having mixed-category co-detections.
- Higher cumulative pathogen detection count was significantly associated with in-hospital mortality (aOR 1.55) and 60-day mortality (aHR 1.42).
- Exploratory threshold of >3 detected targets identified for mortality risk stratification.
Conclusions:
- Cumulative pathogen detection burden in BALF, identified by mPCR, is associated with short-term mortality in a TB-enriched ICU cohort.
- Pathogen detection complexity may offer an exploratory risk-stratification signal, but does not necessarily indicate active infection.
- Prospective multicenter studies are needed to validate this metric for ICU prognostic models.
