PDF(Pubmed)
Abstract：
UNASSIGNED: Lower respiratory tract infections (LRTI)are known to be diagnosed late or inaccurately. This has fueled the unscrupulous use of antibiotics, as they are often used empirically and clinically, leading to antibiotic abuse and multidrug resistance in patients. Metagenomic next-generation sequencing (mNGS), now widely used in clinical studies, could be a potential intervention to revolutionize microbiology by rapidly identifying unknown species.
UNASSIGNED: This review and meta-analysis were conducted on eligible studies with respect to metagenomic sequencing on clinical LRTI diagnostics up to May 01, 2022. QUADAS-2 was employed to assess the methodological bias as well as applicability. After that, a meta-analysis was conducted to analyze the accuracy of mNGS, compared with the composite reference standard (CRS), among the enrolled studies.
UNASSIGNED: This work collected 1248 samples in 13/21 qualified articles to factor in the accuracy of the diagnostic test. Typically, methods like molecular testing, culture, composite measures, and clinical decision-making were adopted as the reference criteria. With regard to Bronchoalveolar Lavage Samples, their sensitivity was 89% (82-93%) while their specificity was 90% (66-98%), with obvious heterogeneities in these two factors as demonstrated by different studies. The summary receiver operating characteristic (SROC) curve was plotted for mNGS as a function of LRTI, and the area under the curve (AUC) was 0.94. A Funnel plot with a p-value greater than 0.05 indicated the absence of publication bias. Positive and negative likelihood ratios (PLR and NLR) were >10 and > 0.1, respectively. In this pre-test probability-post-probability-likelihood ratio relationship graph, the values were Prior prob (%) = 20, Post-prob-Pos (%) = 77 and Post-prob-Neg (%) = 4.
UNASSIGNED: The AUC value of SROC suggested a high accuracy of mNGS in diagnosis, with no publication bias and high reliability. The application of mNGS exhibits notable diagnostic efficacy in discerning pathogens present in bronchoalveolar lavage fluid (BALF) among patients afflicted with LRTI. However, mNGS is more meaningful for the definitive diagnosis of the disease rather than the exclusion of the disease. This post-test probability is significantly higher than the pre-test probability.
UNASSIGNED: This review and meta-analysis were conducted on eligible studies with respect to metagenomic sequencing on clinical LRTI diagnostics up to May 01, 2022. QUADAS-2 was employed to assess the methodological bias as well as applicability. After that, a meta-analysis was conducted to analyze the accuracy of mNGS, compared with the composite reference standard (CRS), among the enrolled studies.
UNASSIGNED: This work collected 1248 samples in 13/21 qualified articles to factor in the accuracy of the diagnostic test. Typically, methods like molecular testing, culture, composite measures, and clinical decision-making were adopted as the reference criteria. With regard to Bronchoalveolar Lavage Samples, their sensitivity was 89% (82-93%) while their specificity was 90% (66-98%), with obvious heterogeneities in these two factors as demonstrated by different studies. The summary receiver operating characteristic (SROC) curve was plotted for mNGS as a function of LRTI, and the area under the curve (AUC) was 0.94. A Funnel plot with a p-value greater than 0.05 indicated the absence of publication bias. Positive and negative likelihood ratios (PLR and NLR) were >10 and > 0.1, respectively. In this pre-test probability-post-probability-likelihood ratio relationship graph, the values were Prior prob (%) = 20, Post-prob-Pos (%) = 77 and Post-prob-Neg (%) = 4.
UNASSIGNED: The AUC value of SROC suggested a high accuracy of mNGS in diagnosis, with no publication bias and high reliability. The application of mNGS exhibits notable diagnostic efficacy in discerning pathogens present in bronchoalveolar lavage fluid (BALF) among patients afflicted with LRTI. However, mNGS is more meaningful for the definitive diagnosis of the disease rather than the exclusion of the disease. This post-test probability is significantly higher than the pre-test probability.
摘要：
■已知下呼吸道感染（LRTI）被诊断为晚期或不准确。这助长了肆无忌惮地使用抗生素，因为它们经常被经验和临床使用，导致患者滥用抗生素和多重耐药性。宏基因组下一代测序（mNGS），现在广泛用于临床研究，可能是通过快速识别未知物种来彻底改变微生物学的潜在干预措施。
■本综述和荟萃分析是针对截至2022年5月1日的临床LRTI诊断的宏基因组测序的合格研究进行的。采用QUADAS-2评估方法学偏差和适用性。之后,进行了荟萃分析，以分析MNGS的准确性，与复合参考标准(CRS)相比，在登记的研究中。
■这项工作在13/21合格的文章中收集了1248个样本，以考虑诊断测试的准确性。通常,分子测试方法，文化,复合措施，并采用临床决策作为参考标准.关于支气管肺泡灌洗样本，其敏感性为89%（82-93%），特异性为90%（66-98%），不同的研究表明，这两个因素具有明显的异质性。作为LRTI的函数，绘制了mNGS的总接受者工作特征（SROC）曲线，曲线下面积(AUC)为0.94。p值大于0.05的漏斗图表明不存在发表偏倚。阳性和阴性似然比（PLR和NLR）分别>10和>0.1。在此预测试概率-后概率-似然比关系图中，这些值是先前的prob(%)=20,post-prob-pos(%)=77和post-prob-Neg(%)=4。
■SROC的AUC值表明mNGS在诊断中具有很高的准确性，无发表偏倚，可靠性高。mNGS的应用在辨别患有LRTI的患者的支气管肺泡灌洗液（BALF）中存在的病原体方面具有显着的诊断功效。然而,mNGS对于疾病的明确诊断而不是排除疾病更有意义。该测试后概率明显高于测试前概率。
■本综述和荟萃分析是针对截至2022年5月1日的临床LRTI诊断的宏基因组测序的合格研究进行的。采用QUADAS-2评估方法学偏差和适用性。之后,进行了荟萃分析，以分析MNGS的准确性，与复合参考标准(CRS)相比，在登记的研究中。
■这项工作在13/21合格的文章中收集了1248个样本，以考虑诊断测试的准确性。通常,分子测试方法，文化,复合措施，并采用临床决策作为参考标准.关于支气管肺泡灌洗样本，其敏感性为89%（82-93%），特异性为90%（66-98%），不同的研究表明，这两个因素具有明显的异质性。作为LRTI的函数，绘制了mNGS的总接受者工作特征（SROC）曲线，曲线下面积(AUC)为0.94。p值大于0.05的漏斗图表明不存在发表偏倚。阳性和阴性似然比（PLR和NLR）分别>10和>0.1。在此预测试概率-后概率-似然比关系图中，这些值是先前的prob(%)=20,post-prob-pos(%)=77和post-prob-Neg(%)=4。
■SROC的AUC值表明mNGS在诊断中具有很高的准确性，无发表偏倚，可靠性高。mNGS的应用在辨别患有LRTI的患者的支气管肺泡灌洗液（BALF）中存在的病原体方面具有显着的诊断功效。然而,mNGS对于疾病的明确诊断而不是排除疾病更有意义。该测试后概率明显高于测试前概率。
