Clinical Value of Metagenomics Next-Generation Sequencing in Bronchoalveolar Lavage Fluid for Patients with Severe Hospital-Acquired Pneumonia: A Nested Case–Control Study

Figures & data

Figure 1 Flow diagram.

Abbreviations: BALF, bronchoalveolar lavage fluid; CRRT, continuous renal replacement therapy; ECMO, extracorporeal membrane oxygenation.

Table 1 Demographic and Clinical Characteristics of the Two Group Patients Included in the Study

	mNGS Group	CMT Group	p value
Male/female (n)	21/12	42/24	1
Age (year)	63.09±15.3	63.09±15.2	1
APACHE II score	17.0±4.80	17.0±4.80	1
PSI score
Grade III (n)	7	14	1
Grade IV (n)	26	52	1
CRRT implementation (n)	6	12	1
ECMO implementation (n)	2	4	1
Organ transplant (n)	4	8	1
Immunosuppressor (n)	14	28	1
Comorbidities
Organ transplant (n)	4	8	1
COPD (n)	2	4	1
Hematologic neoplasms (n)	2	4	1
Cerebral hemorrhage	3	6	1
Interstitial pneumonia	1	2	1
AMI	2	4	1
Hyperthyroid crisis	1	2	1
ANCA-associated vasculitis	2	4	1
Solid tumors	4	8	1
Ischemic stroke	2	4	1
Traumatic brain injury	5	10	1
Lower respiratory tract infection	3	6	1
Type of infection (n)
HAP but not VAP	3	6	1
VAP	30	60	1
Time from hospitalization to diagnosis of nosocomial pneumonia (days)	6.6±1.6	7.2±2.3	0.138
Time from diagnosis of HAP to specimen collection (hours)	9.1±2.8	9.5±3.0	0.512
Time of sample submission to results feedback (hours)	21.8±2.3	80.3±5.3	<0.001

Abbreviations: APACHE II, acute physiology and chronic health evaluation II; PSI, Pneumonia Severity Index; CRRT, continuous renal replacement therapy; ECMO, extracorporeal membrane oxygenation; COPD, chronic obstructive pulmonary disease; AMI, acute myocardial infarction; ANCA, anti-neutrophil cytoplasmic antibody; HAP, hospital-acquired pneumonia; VAP, Ventilator-associated pneumonia.

Figure 2 The genus distribution of microorganisms detected by mNGS and CMT. 37 patients underwent PCR test for viruses produced 8 positive results, including 5 EBV and 3 CMV.

Abbreviations: HSV-1, herpes simplex virus-1; CMV, cytomegalovirus; EBV, Epstein-Barr virus EBV; HPIV-3, Human Parainfluenza Virus type 3; HHV-6B, Human Herpesvirus-6B.

Table 2 The Treatment and Prognosis of Patients Received mNGS and CMT

	mNGS Group (n = 33)	Non-mNGS Group (n = 66)	p value
Antibiotic adjustments (n, %)	23 (70.0%)	29 (43.9%)	0.016
Duration of mechanical Ventilation (hours)	264.0 (154–456)	140.5 (97–261)	0.001
Length of ICU stay (days)	14 (10–23)	9 (6–14)	<0.001
Pulmonary infections improved (n, %)	20 (60.6%)	25 (37.9%)	0.032
Mortality in 7 days (n, %)	6.1% (2)	25.8% (17)	0.02
Mortality in 28 days (n, %)	33.3% (11)	31.2% (21)	1
Mortality in 90 days (n, %)	48.5% (16)	45.5% (30)	0.776

Figure 3 Antibiotic adjustment in the two groups according to the test results.

Figure 4 Kaplan–Meier curves for 90-day mortality in mNGS and CMT patients. P =0.98, OR=1.95%; CI=0.55–1.85.