Abstract: Ｏｂｊｅｃｔｉｖｅ：This retrospective study was to evaluate the diagnostic value and clinical application of metagenomic nextgeneration sequencing (mNGS) for infections in immunosuppressed patients of renal intensive care unit (ICU).
Ｍｅｔｈｏｄｏｌｏｇｙ：We retrospectively analyzed immunosuppressed chronic kidney disease (CKD) patients suspected of infection admitted to the ICU of National Clinical Research Center of Kidney Diseases, Jinling Hospital from August 2018 to April 2022. We divided them into conventional microbiological tests (CMT) confirmed infection group, clinically diagnosed infection group and exclusion of infection group, and then compared the microbiological detection efficiency between mNGS and CMT.
Ｒｅｓｕｌｔｓ：The 303 patients involved in this study used 2(1, 3) types of immunosuppressants, with a median time of 7(2, 50) months. The median CD4+T value was 14950(8125, 26225)／μL, and the inhospital mortality was 2046％. In the CMT confirmed infection group, 3879％ of mNGS were completely consistent with CMT results, accompanied by 2788％ partially consistent with 3333％ inconsistent. In the clinically diagnosed infection group, 5769％ of infected pathogens could be detected by mNGS. We found that mNGS outperformed culture in terms of tested positive time and the high microbial detection. The sensitivity and accuracy of mNGS in infection diagnosis were much higher than that of CMT. Nevertheless, there was no significant difference in specificity, positive and negative predictive values.
Ｃｏｎｃｌｕｓｉｏｎ：mNGS can improve the sensitivity and accuracy of infection pathogen detection in immunosuppressed CKD patients. mNGS is emerging as a promising technique to detect copathogens in infection with potential benefits in speed and sensitivity, which may provide more diagnostic evidence in opportunistic infection or rare infection pathogens.