Application of metagenomic next-generation sequencing for suspected infected pancreatic necrosis |
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| Institution: | 1. Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China;2. National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China;3. Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China;1. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA;2. Division of Pediatric Gastroenterology, Hepatology & Nutrition, Lucille Packard Children''s Hospital at Stanford, Stanford, CA, USA;3. Department of Biostatistics, University of Pittsburgh, Pittsburg, PA, USA;4. Nationwide Children''s Hospital, Columbus, OH, USA;5. University of Pittsburgh, School of Dental Medicine, Pittsburg, PA, USA;6. University of Pittsburgh, School of Medicine, Pittsburg, PA, USA;7. Johns Hopkins Medical Institutions, Baltimore, MD, USA;8. Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China;9. The Ohio State University Wexner Medical Center, Columbus, OH, USA;1. Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA;2. Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA;3. Division of Gastroenterology, Brigham & Women''s Hospital, Boston, MA, USA;4. Mercy Clinic Gastroenterology, St. Louis, MO, USA;5. Division of Gastroenterology & Hepatology, Mayo Clinic, Phoenix, AZ, USA;6. Division of OneGI, Tupelo, MS, USA;7. Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA;8. Division of Gastroenterology, Oregon Health Science University, Portland, OR, USA;9. Division of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, Hanover, NH, USA;10. GastroHealth, Miami, FL, USA;11. Aurora St. Luke''s Medical Center, Milwaukee, WI, USA;12. Division of Gastroenterology, Hepatology & Nutrition, University of Florida, Gainesville, FL, USA;13. Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, FL, USA;14. Division of Gastroenterology & Hepatology, Indiana University, Indianapolis, IN, USA;15. Digestive Diseases, Yale University, New Haven, CT, USA;p. Palmetto Health, Columbia Gastroenterology Associates, Columbia, SC, USA;q. Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA;r. Gastroenterology Associates, Richmond, VA, USA;s. Division of Gastroenterology & Hepatology, University of Alabama, Birmingham, AL, USA;1. Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA;2. Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India;3. Division of Pediatric Gastroenterology, Lucile Packard Children''s Hospital Stanford, Palo Alto, CA, USA;4. Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands;5. Department of Gastroenterology, Postgraduate Institute of Medical Education & Research, Chandigarh, India;6. Department of Gastroenterology, Apollo Multispecialty Hospitals, Kolkata, India;7. Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore;1. Department of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA;2. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA |
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| Abstract: | BackgroundMetagenomic 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).ObjectiveTo investigate the clinical application value of mNGS in the pathogenic diagnosis of IPN.MethodsForty-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.ResultsA 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).ConclusionsWith more valuable diagnostic performance and shorter turnaround time, clinical mNGS represents a potential step forward in the early diagnosis of IPN. |
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| Keywords: | Infected pancreatic necrosis Metagenomic next-generation sequencing Early diagnosis |
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