宏基因组二代测序驱动抗生素策略优化对脓毒症患者预后的影响:一项基于倾向性评分匹配分析的研究OA

Objective To investigate the clinical value of metagenomic next-generation sequencing(mNGS)in patients with sepsis and to evaluate its impact on pathogen detection rate and in-hospital mortality.Methods A total of 377 patients with sepsis admitted to the Emergency Intensive Care Unit of the First Affiliated Hospital of Wenzhou Medical University from January 2021 to May 2024 were retrospectively enrolled.They were divided into the mNGS group(181 cases)and the non-mNGS group(196 cases)according to whether they underwent mNGS testing.A 1:1 propensity score matching was performed,resulting in 176 matched pairs.Baseline characteristics,pathogen detection status,and clinical outcomes were compared between the two groups.Multivariate logistic regression analysis was used to explore the correlation between mNGS testing and in-hospital mortality in different subgroups.Results The overall pathogen detection rate and the rate of polymicrobial detection in the mNGS group(20.45%)were significantly higher than those in the non-mNGS group(2.84%).The negative detection rate in the mNGS group(28.98%)was lower than that in the non-mNGS group(51.14%),P<0.05.The rate of antibiotic regimen adjustment was also higher in the mNGS group(P<0.05).Taking traditional microbial culture as the reference standard,the sensitivity and specificity of mNGS were 85.11%and 39.53%,respectively.There was no significant difference in overall in-hospital mortality between the two groups(11.93%vs.18.18%,P>0.05).Subgroup analyses revealed that mNGS testing was associated with reduced in-hospital mortality in patients with abdominal infection,aged≥65 years,and with Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE II)score≥16.5(OR=0.240,95%CI:0.068-0.846,P=0.026;OR=0.350,95%CI:0.139-0.881,P=0.026;OR=0.416,95%CI:0.176-0.985,P=0.046).Conclusions mNGS improves pathogen detection rates in patients with sepsis,demonstrating advantages in identifying polymicrobial infections and atypical pathogens,and influencing antibiotic treatment adjustments.Although no significant improvement in in-hospital mortality was observed in the overall population,survival benefits may be achieved in specific subgroups including elderly patients,those with intra-abdominal infection,and those with greater disease severity.The clinical value of mNGS may be more precisely realized in targeted high-risk subgroups through optimized precision management.