| ObjectiveThis study aimed to analysis the risk factors of pulmonary aspergillosis in nonneutropenic patients to establish a prediction model,obtain further in-depth information on the value of metagenomic next-generation sequencing(m NGS)for diagnosing pulmonary aspergillosis in non-neutropenic patients and provide ideas for more reasonable clinical diagnosis and treatment.MethodPart I: There was a retrospective analysis of the clinical medical data of 57 nonneutropenic patients with Fungi sequences detected by m NGS(BALF and/or blood and/or pleural fluid samples)in the Department of Respiratory and Critical Care Medicine of our hospital from June 2018 to November 2022.Through comprehensive clinical diagnosis,19 cases were diagnosed as pulmonary aspergillosis,and 38 cases were diagnosed as nonpulmonary aspergillosis.Meanwhile,the following analysis were carried out:1.The analysis of the clinical characteristics,radiologic features and laboratory tests of pulmonary aspergillosis patients and non-pulmonary aspergillosis patients.2.The summary,Logistic regression analysis,and Nomogram analysis of risk factors of pulmonary aspergillosis in non-neutropenic patients based on the above results to establish the prediction model.Part II: The research objects and methods were the same as those in part I,and the following analysis was carried out:1.The comparison of the accuracy of m NGS with conventional etiological methods and serum(1,3)-β-D-glucan in the diagnosis of pulmonary aspergillosis in non-neutropenic patients.2.The exploration of the efficacy of m NGS in detecting mixed infections and copathogen.3.Reviewing modifications of antimicrobial therapy and follow-up of efficacy for patients with pulmonary aspergillosis according to the m NGS results.4.Comparing the detection of Aspergillus in bronchoalveolar lavage fluid and blood samples from two patients using m NGS.5.The analysis of the proportion of various Aspergillus detected in pulmonary aspergillosis patients and the correlation between the number of detected Aspergillus sequences and various clinical indicators.6.Exploring the cutoff value of the number of Aspergillus sequences detected by m NGS for the diagnosis of pulmonary aspergillosis.ResultIn the first part,the comparison was made between pulmonary aspergillosis and nonpulmonary aspergillosis in the 57 included non-neutropenic patients.There were differences in diabetes mellitus,wedge and patchy shadowing,cavitation sign,albumin,high D-dimer,and the number of Aspergillus sequences detected by m NGS between the two groups.Logistic regression and Nomogram analysis were performed on the differences data.A prediction model for the occurrence of pulmonary aspergillosis in non-neutropenic patients was established.The cavitation sign and the number of Aspergillus sequences detected by m NGS were independent risk factors for pulmonary aspergillosis in nonneutropenic patients.In the second part,our research found that m NGS managed to reach the sensitivity of89.5% for diagnosing pulmonary aspergillosis,which was significantly higher than that of conventional etiological methods(33.3%)and serum(1,3)-β-D-glucan(31.3%),and the specificity reached 81.6%.In addition,m NGS showed superior performance in discovering mixed infections and co-pathogens(89.5%)of pulmonary aspergillosis.Aspergillus merged bacteria,Aspergillus merged bacteria-other fungi-virus were most commonly observed in non-neutropenic patients.Moreover,m NGS results can help guide clinical medication.According to the m NGS results,antimicrobial therapy was altered in 94.7% of patients with pulmonary aspergillosis,among them 57.9% were started with antiAspergillus drugs,and follow-up of efficacy further confirmed the value of m NGS.Additionally,it is worth noting that simultaneous m NGS of BALF and blood samples obtained from the same patient showed highly consistent results in detection of Aspergillus.Finally,the types of Aspergillus detected by m NGS in non-neutropenic patients with pulmonary aspergillosis were analyzed,mainly Aspergillus fumigatus.Meanwhile,the number of Aspergillus sequences detected was no significantly correlated with the clinical index.When the detection sequence number of m NGS was 0.5,the Yoden index was the largest in the diagnosis of pulmonary aspergillosis.ConclusionThe established prediction model of the occurrence of pulmonary aspergillosis in nonneutropenic patients can guide the use of anti-Aspergillus drugs and has the potential to improve the prognosis of patients.m NGS is a useful method for the diagnosis of pulmonary aspergillosis in non-neutropenic patients,detection of co-pathogens,and adjustment of antimicrobial treatment. |
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