[Metagenomic next-generation sequencing of plasma for the identification of bloodstream infectious pathogens in severe aplastic anemia].

• DOI: 10.3760/cma.j.issn.0253-2727.2023.03.010
• Publication Date: 2023-03-14
• Authors: Y Li; Yuanyuan Xiong; Huihui Fan; L P Jing; J P Li; Qingsong Lin; Chunhui Xu; Y Li; L Ye; Meng Jiao; Yong Yang; Y Li; Wenrui Yang; Guangxin Peng; Kang Zhou; Xin Zhao; Li Zhang; F K Zhang
• Keywords: Aplastic anemia; Hematology

Objective: To analyze the diagnostic value of cell-free plasma metagenomic next-generation sequencing (mNGS) pathogen identification for severe aplastic anemia (SAA) bloodstream infection. Methods: From February 2021 to 2022, mNGS and conventional detection methods (blood culture, etc.) were used detect 33 samples from 29 consecutive AA patients admitted Anemia Diagnosis Treatment Center Hematology Hospital Chinese Academy Medical Sciences assess consistency detection, as well impact on clinical treatment benefits accuracy. Results: ①Among evaluated by methods, 25 cases (75.76%) carried potential pathogenic microorganisms. A total 72 microorganisms identified all cases, which 65 (90.28%) detected only mNGS. ②All consistency, 2 (6.06%) Composite, 18 (54.55%) only, Conventional method 1 case (3.03%) was both common compliances (mNGS/Conventional testing) , 10 (30.3%) completely non-conforming (None) . ③All benefit. Among them, 8 (24.24%) received Initiation targeted treatment, de-escalation, 13 (39.39%) Confirmation, remaining 11 (33.33%) No ④ The sensitivity 80.77%, specificity 70.00%, positive predictive 63.64%, negative 84.85%, likelihood ratio 2.692, 0.275 distinguished (21/12 vs 5/28, P<0.001) Conclusion: can not contribute accurately diagnosing infection in with anemia, but also help guide accurate anti-infection accuracy is high.目的： 评估无细胞血浆宏基因组二代测序（mNGS）病原体识别对重型再生障碍性贫血（AA）血流感染的诊断意义。 方法： 应用mNGS与常规检测方法（血培养等）同步检测2021年2月至2022年2月中国医学科学院血液病医院贫血诊疗中心连续收治的29例AA患者共33例次送检样本，评估mNGS与常规检测的诊断一致性、对临床治疗获益的影响及临床准确度。 结果： ①33例次患者经mNGS和常规检测方法检测，其中25例次（75.76%）检出潜在病原微生物；共检出病原微生物72株，其中65株（90.28%）仅经mNGS检出。②诊断一致性评估：2例次（6.06%）组合符合（Composite），18例次（54.55%）mNGS唯一符合（mNGS only），2例次（6.06%）常规检测方法唯一符合（Conventional testing only），1例次（3.03%）共同符合（mNGS/Conventional testing），10例次（30.3%）完全不符合（None）。③临床治疗获益评估：8例次（24.24%）为启动靶向治疗（Initation treatment），1例次（3.03%）为降级治疗（Treatment de-escalation），13例次（39.39%）为确认治疗（Confirmation），11例次（33.33%）为无治疗获益（No benefit）。④临床准确度：mNGS与常规检测方法差异有统计学意义（21/12对5/28，P<0.001），mNGS的敏感性80.77%，特异性70.00%，阳性预测值63.64%，阴性预测值84.85%，阳性似然比2.692，阴性似然比0.275。 结论： mNGS不仅有助于精准诊断AA患者的血流感染，而且有利于指导进行精准抗感染治疗，临床准确度高。.