mNGS在EICU脓毒症患者中的临床应用及影响因素OA

[Objective]To explore the clinical value of metagenomic next-generation sequencing(mNGS)in patients with sepsis admitted to the Emergency Intensive Care Unit(EICU),evaluate its role in guiding precision antimicrobial therapy,and to identify key factors influencing mNGS positivity and patient prognosis.[Methods]This retrospective study analyzed clinical data from 524 patients with sepsis admitted to the EICU of Sun Yat-sen Memorial Hospital,Sun Yat-sen University,from November 2020 to October 2024.The positive detection rate,pathogen spectrum,and concordance between mNGS and conventional culture were compared.Factors including infection site,underlying diseases,and immune status associated with mNGS positivity were evaluated.The impact of adjusting antimicrobial therapy based on mNGS results on patient prognosis was also analyzed.[Results]The positive detection rate of mNGS was significantly higher than that of conventional culture(85.11%vs.47.14%,P＜0.001).mNGS enabled rapid identification of rare pathogens and mixed infections,with higher positivity observed in immunosuppressed patients and those with hematological disorders(P＜0.05).Adjustment of antimicrobial therapy based on mNGS results showed no significant difference in short-term clinical response;however,28-day mortality differed significantly among groups(adjusted group 39.1%,non-adjusted group 76.3%,supportive group 31.4%;χ²=22.44,P＜0.001).Multivariate logistic regression analysis identified age and mechanical ventilation as independent factors associated with pathogen positivity.Age,coronary heart disease,SOFA score,bilirubin level,and the use of mechanical ventilation and vasoactive drugs were independent risk factors for 28-day mortality,whereas platelet count and renal function showed protective associations.Patients whose antimicrobial therapy was adjusted based on mNGS results demonstrated a trend toward clinical improvement,shorter antibiotic duration,faster fever resolution,and lower 28-day case fatality rate.[Conclusion]mNGS demonstrates high sensitivity and broad pathogen coverage for etiological diagnosis in EICU sepsis patients and provides critical support for precision antimicrobial therapy.Patient age,underlying diseases,disease severity,and organ function are key determinants of pathogen detection and short-term prognosis,offering valuable guidance for risk stratification and optimization of therapeutic strategies.