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Diagnostic Evaluation of Pneumocystis Pneumonia by Metagenomic Next-Generation Sequencing in Immunosuppressive Patients Undergoing Mechanical Ventilation in the Intensive Care Unit
34 Pages Posted: 17 Jul 2023
More...Abstract
Background: Pneumocystis jirovecii is an opportunistic pathogen which can cause fatal Pneumocystis
pneumonia (PCP). The precise diagnosis of PCP remains challenging for its heterogeneity of clinical presentation.
Methods:
We performed a retrospective cohort study of patients in ICU from March 2018 to May 2020. All cases were immunosuppressed due to organ transplantation, cancer or autoimmune diseases, and performed metagenomic next-generation sequencing (mNGS) for pathogen identification.
Results: A total of 46 immunocompromised cases were enrolled in this study. 17 of 46 cases were diagnosed with PCP by combining with imaging examination and other clinical detection methods. The LDH level and the positive rate of β-D-glucan assay were higher in PCP group than non-PCP group, 594(506~733) vs. 456(342~576), p = 0.006;
14/17(82.4%) vs. 10/29(34.5%), p = 0.005. APACHE II score of PCP group was lower
than Non-PCP group, 20(16~26) vs. 25(19~30), p = 0.039. The sensitivity and specificity of mNGS for the diagnosis of PCP were both 100%, while those of β-D-glucan assay combined with LDH were 41.2% and 86.2%, respectively. If we assume that positive result of Β-D-glucan assay, LDH >255 U/L, APACHE II score ≤ 27 as
the screening standard, compared with mNGS method, the specificity and sensitivity for the diagnosis of PCP are 82.4% and 86.2% respectively.
Conclusionsm: NGS could be a promising technology to diagnose PCP and detect mixed infections
in pulmonary infection in immunosuppressed patients, Combined APACHE II/BG/LDH with mNGS might be a rapid screening method for PCP diagnosis.
Funding: This study was funded by National Key Research and Development Program of China (2022YFC0869400), National Natural Science Foundation of China (Grant No. 82270081), Emergency Key Program of Guangzhou Laboratory (Grant No. EKPG21- 17), National Natural Science Foundation of China (Grant No. 81870069), Selfdetermined Project of GIRH (2019GIRHQ05) , Natural Science Foundation of Guangdong Province (2020A1515011459) and Zhongnanshan Medical Fundation of Guangdong Province(2020B1111340017).
Declaration of Interest: All authors declare that they have no competing interests.
Ethical Approval: The study was approved by the Institutional Ethics Committee of the First Affiliated Hospital of Guangzhou Medical University (No.2020K-42). Informed consent was waived by the ethics committee due to the retrospective nature of study design.
Keywords: PCP, mNGS, Dignosis, ICU, LDH, Pneumocystis jirovecii
Suggested Citation: Suggested Citation