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Abstract：
UNASSIGNED: To explore the clinical utility of metagenomic next-generation sequencing (mNGS) in diagnosing invasive pulmonary aspergillosis (IPA) among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the intensive care unit (ICU).
UNASSIGNED: A retrospective analysis was conducted on patients with AECOPD admitted to the ICU of Xinxiang Central Hospital in Henan Province, China, between March 2020 and September 2023, suspected of having IPA. Bronchoalveolar lavage fluid (BALF) samples were collected for fungal culture, the galactomannan (GM) test, and mNGS. Based on host factors, clinical features, and microbiological test results, patients were categorized into 62 cases of IPA and 64 cases of non-IPA. Statistical analysis was performed to compare the diagnostic efficacy of fungal culture, the serum and BALF GM test, and mNGS detection for IPA in patients with AECOPD.
UNASSIGNED: 1. The sensitivity and specificity of mNGS in diagnosing IPA were 70.9% and 71.8% respectively, with the sensitivity of mNGS surpassing that of fungal culture (29.0%, P<0.01), serum GM test (35.4%, P<0.01), and BALF GM test (41.9%, P<0.05), albeit with slightly lower specificity compared to fungal culture (90.6%, P >0.05), serum GM test (87.5%, P >0.05), and BALF GM test (85.9%, P >0.05).Combining fungal culture with the GM test and mNGS resulted in a sensitivity of 80.6% and a specificity of 92.2%, underscoring a superior diagnostic rate compared to any single detection method. 2.mNGS accurately distinguished strains of the Aspergillus genus. 3.The area under the ROC curves of mNGS was 0.73, indicating good diagnostic performance. 4.The detection duration for mNGS is shorter than that of traditional fungal culture and GM testing.
UNASSIGNED: mNGS presents a pragmatic and highly sensitive approach, serving as a valuable complementary tool to conventional microbiological tests (CMT). Our research demonstrated that, compared to fungal culture and GM testing, mNGS exhibits superior diagnostic capability for IPA among patients with AECOPD. Integration of mNGS with established conventional methods holds promise for improving the diagnosis rate of IPA.
UNASSIGNED: A retrospective analysis was conducted on patients with AECOPD admitted to the ICU of Xinxiang Central Hospital in Henan Province, China, between March 2020 and September 2023, suspected of having IPA. Bronchoalveolar lavage fluid (BALF) samples were collected for fungal culture, the galactomannan (GM) test, and mNGS. Based on host factors, clinical features, and microbiological test results, patients were categorized into 62 cases of IPA and 64 cases of non-IPA. Statistical analysis was performed to compare the diagnostic efficacy of fungal culture, the serum and BALF GM test, and mNGS detection for IPA in patients with AECOPD.
UNASSIGNED: 1. The sensitivity and specificity of mNGS in diagnosing IPA were 70.9% and 71.8% respectively, with the sensitivity of mNGS surpassing that of fungal culture (29.0%, P<0.01), serum GM test (35.4%, P<0.01), and BALF GM test (41.9%, P<0.05), albeit with slightly lower specificity compared to fungal culture (90.6%, P >0.05), serum GM test (87.5%, P >0.05), and BALF GM test (85.9%, P >0.05).Combining fungal culture with the GM test and mNGS resulted in a sensitivity of 80.6% and a specificity of 92.2%, underscoring a superior diagnostic rate compared to any single detection method. 2.mNGS accurately distinguished strains of the Aspergillus genus. 3.The area under the ROC curves of mNGS was 0.73, indicating good diagnostic performance. 4.The detection duration for mNGS is shorter than that of traditional fungal culture and GM testing.
UNASSIGNED: mNGS presents a pragmatic and highly sensitive approach, serving as a valuable complementary tool to conventional microbiological tests (CMT). Our research demonstrated that, compared to fungal culture and GM testing, mNGS exhibits superior diagnostic capability for IPA among patients with AECOPD. Integration of mNGS with established conventional methods holds promise for improving the diagnosis rate of IPA.
摘要：
■探讨宏基因组下一代测序（mNGS）在重症监护病房（ICU）慢性阻塞性肺疾病急性加重（AECOPD）患者侵袭性肺曲霉病（IPA）诊断中的临床应用价值。
■对河南省新乡市中心医院ICU收治的AECOPD患者进行回顾性分析,中国,在2020年3月至2023年9月之间，怀疑有IPA。收集支气管肺泡灌洗液（BALF）样品进行真菌培养，半乳甘露聚糖（GM）试验，和mNGS。基于宿主因素，临床特征,和微生物测试结果，患者分为IPA62例和非IPA64例。进行统计学分析以比较真菌培养的诊断功效,血清和BALFGM测试，并对AECOPD患者的IPA进行mNGS检测。
■1.mNGS诊断IPA的敏感性和特异性分别为70.9%和71.8%。mNGS的灵敏度超过真菌培养(29.0%，P<0.01),血清GM测试(35.4%，P<0.01),和BALFGM测试(41.9%，P<0.05),尽管与真菌培养相比特异性略低(90.6%，P>0.05)，血清GM测试(87.5%，P>0.05)，和BALFGM测试(85.9%，P>0.05)。将真菌培养与GM测试和mNGS相结合，灵敏度为80.6%，特异性为92.2%，强调与任何单一检测方法相比，诊断率更高。2.mNGS准确区分曲霉属的菌株。3.mNGS的ROC曲线下面积为0.73，表明诊断性能良好。4.mNGS的检测时间比传统真菌培养和转基因检测短。
■mNGS提出了一种务实且高度敏感的方法，作为传统微生物测试（CMT）的有价值的补充工具。我们的研究表明,与真菌培养和转基因测试相比，在AECOPD患者中，mNGS对IPA具有优越的诊断能力。mNGS与已建立的常规方法的整合有望提高IPA的诊断率。
■对河南省新乡市中心医院ICU收治的AECOPD患者进行回顾性分析,中国,在2020年3月至2023年9月之间，怀疑有IPA。收集支气管肺泡灌洗液（BALF）样品进行真菌培养，半乳甘露聚糖（GM）试验，和mNGS。基于宿主因素，临床特征,和微生物测试结果，患者分为IPA62例和非IPA64例。进行统计学分析以比较真菌培养的诊断功效,血清和BALFGM测试，并对AECOPD患者的IPA进行mNGS检测。
■1.mNGS诊断IPA的敏感性和特异性分别为70.9%和71.8%。mNGS的灵敏度超过真菌培养(29.0%，P<0.01),血清GM测试(35.4%，P<0.01),和BALFGM测试(41.9%，P<0.05),尽管与真菌培养相比特异性略低(90.6%，P>0.05)，血清GM测试(87.5%，P>0.05)，和BALFGM测试(85.9%，P>0.05)。将真菌培养与GM测试和mNGS相结合，灵敏度为80.6%，特异性为92.2%，强调与任何单一检测方法相比，诊断率更高。2.mNGS准确区分曲霉属的菌株。3.mNGS的ROC曲线下面积为0.73，表明诊断性能良好。4.mNGS的检测时间比传统真菌培养和转基因检测短。
■mNGS提出了一种务实且高度敏感的方法，作为传统微生物测试（CMT）的有价值的补充工具。我们的研究表明,与真菌培养和转基因测试相比，在AECOPD患者中，mNGS对IPA具有优越的诊断能力。mNGS与已建立的常规方法的整合有望提高IPA的诊断率。
