Study On The Value Of Cerebrospinal Fluid Metagenomic Next-generation Sequencing In Early Diagnosis And Treatment Of Children With Purulent Meningitis

Objective:The medical history,signs,serological examination,cerebrospinal fluid examination,neuroelectrophysiological examination,neuroimaging examination and cerebrospinal fluid metagenomic second-generation sequencing results of children with suppurative meningitis were retrospectively analyzed,to explore the value of cerebrospinal fluid metagenomic second-generation sequencing in the early diagnosis and treatment of children with suppurative meningitis,and to study its influencing factors.Methods:From January 2015 to June 2021,116 children with purulent meningitis were diagnosed in the pediatric neurological ward of Shengjing Hospital of China Medical University.Clinical data of all cases were retrospectively collected.Including medical history,signs,routinecerebrospinalfluid examination results,Neuroelectrophysiological examination,neuroimaging examination results,cerebrospinal fluid metagenomic second-generation sequencing results as well as cerebrospinal fluid acquisition time and prognosis,the patients were divided into cerebrospinal fluid routine diagnosis group and cerebrospinal fluid metagenomic second-generation sequencing diagnosis group.Meanwhile,the cerebrospinal fluid metagenomic second-generation sequencing group was further divided into positive group and negative group.To analyze the factors influencing the positive rate of cerebrospinal fluid metagenomic sequencing in children with purulent meningitis.The normal or nearly normal measurement data in the measurement data were described in the form of mean value and standard deviation,and the measurement data was analyzed by t test.For data that did not conform to normal distribution,median(quartile)description and a non-parametric test(U test)difference analysis were used.A multi-factor logistic regression model was established,and the mNGS result was used as the dependent variable(positive value was 1,negative value was 0),and a single factor with P value less than 0.1 was included with the variable.In the subsequent binary logistic regression model,OR value was used as the risk assessment parameter,and P<0.05 was statistically significant.Results:The clinical data of children suspected to be purulent meningitis admitted to a third Class A hospital were retrospectively analyzed.A total of 116 cases meeting the inclusion criteria were collected.There were 56 cases in the cerebrospinal fluid routine diagnosis group and 60 cases in the cerebrospinal fluid metagenomic second-generation sequencing diagnosis group.The results showed as follows:1.The median length of stay in the cerebrospinal fluid routine diagnosis group was 16.5 days,and the median length of stay in the cerebrospinal fluid metagenomic second-generation sequencing diagnosis group was 11 days,which was significantly lower than that in the cerebrospinal fluid routine diagnosis group.2.The median hospitalization cost of the cerebrospinal fluid routine diagnosis group was 25,299.11 yuan,and the median hospitalization cost of the cerebrospinal fluid metagenomic second-generation sequencing diagnosis group was 17195.42 yuan,which was significantly lower than that of the cerebrospinal fluid routine diagnosis group.3.The positive rates of symptoms,signs and laboratory results in the whole group were as follows:headache 14.66%,altered state of consciousness 31.03%,neck strong positive 18.97%,Kerr sign positive 27.59%,cerebrospinal fluid bacterial culture positive 8.33%,cerebrospinal fluid metagenomic second-generation sequencing method 45.00%,blood bacterial culture positive 13.33%,and the positive rate of cerebrospinal fluid metagenomic second-generation sequencing method was significantly higher than that of blood bacterial culture and cerebrospinal fluid bacterial culture.4.The higher the blood C-reactive protein,the higher the positive rate of cerebrospinal fluid metagenomic second-generation sequencing,which is valuable for the early accurate diagnosis and guidance of treatment of purulent meningitis.The positive rate of cerebrospinal fluid metagenomic second-generation sequencing was higher in patients with positive blood culture(87.5%vs 39.0%).Negative blood culture could not exclude the diagnosis of purulent meningitis.5 At discharge,the prognosis of the cerebrospinal fluid metagenomic second-generation sequencing group was better than that of the conventional cerebrospinal fluid group,suggesting that early application of mNGS in children with purulent meningitis of unknown etiology could improve the prognosis.Conclusion:The mean hospital stay of children with purulent meningitis was less in the cerebrospinal fluid metagenomic second generation sequencing group.The cerebrospinal fluid metagenomic second-generation sequencing and diagnosis group had lower hospitalization costs;The positive rate of cerebrospinal fluid metagenomic second generation sequencing method was significantly higher than that of blood and cerebrospinal fluid bacterial culture.The higher the level of C-reactive protein and procalcitonin,the higher the positive rate of cerebrospinal fluid metagenomic second-generation sequencing.The prognosis of children in the cerebrospinal fluid metagenomic second-generation sequencing group after early adjustment of treatment regimen was better than that in the conventional cerebrospinal fluid diagnosis group.mNGS detection can help the accurate diagnosis of purulent meningitis,and is valuable for the early accurate.diagnosis and guidance of accurate treatment of purulent meningitis..