mNGS and Sepsis Mortality Reduction
Objectives: Sepsis is a significant public health problem and a life-threatening condition characterized by organ dysfunction due to a dysregulated host response to infection. To evaluate the application value of metagenomic next-generation sequencing (mNGS) in the treatment of intensive care unit (ICU) sepsis and its impact on prognosis.Methods: We reviewed 303 sepsis patients admitted to the ICU from January 2021 to December 2022. These patients were divided into the mNGS group (93 cases) and the no mNGS group (130 cases). Statistical analysis was performed using Linear Regression(LR), Binary Regression (BR) , Propensity Score Matching (PSM) and Mediation Analysis. Results: A 1:1 PSM was performed for the two groups, propensity matching was possible for 80 patients who underwent mNGS detection with 80 patients. In the matched cohort, the antibiotics adjustment based on pathogenic results was more frequent (P<0.01), the time of ICU stays and the hospitalization cost were undifferentiated in the mNGS group than in the no mNGS group (P＞0.05). BR analysis further confirmed the significant relationship between mNGS detection and the likelihood of antibiotic adjustment (OR=0.026, P<0.01) and the time of antibiotic adjustment(OR=0.663, P<0.01). Each one score increase in SOFA was associated with a 5% higher risk of mortality (OR=1.174, 95% CI [1.074, 1.283], P=0.001). The decision of antibiotic adjustment (OR=4.205, P=0.001), urinary tract infection (OR=3.682, P=0.024) and the negative etiological culture (OR=3.268, P=0.047) were significantly positive associated with 28-day mortality. The treatments of mechanical ventilation (OR=0.275, P=0.004) and CRRT (OR=0.191, P=0.001) were negative related with 28-day mortality. However, the indirect effect mNGS detection on 28-day mortality through antibiotics adjustment was not significant (Z=0.367, P=0.714).Conclusion: mNGS significantly influences the decision of antibiotic adjustment and the outcomes of sepsis patients,which would not raise higher costs and longer ICU stay and be worth highlighting its potential for broader clinical application.
