Exploring the appropriate situation of performing CSF mNGS in patients with proposed intracranial infections.

IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY
Jinliang Deng, Xiuxiao Chen, Yi Bu, Jinru Zhang, Jingzhe Han
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引用次数: 0

Abstract

Background: Identifying the responsible pathogen is crucial for precision medicine in intracranial infections, and Cerebrospinal Fluid (CSF) Metagenomic Next-Generation Sequencing (mNGS) is a reliable method for this detection. However, the indiscriminate utilization of this approach may impose a financial burden on both patients and society. The study aims to investigate the optimal conditions for applying CSF mNGS in patients with suspected intracranial infections, offering valuable references for precision medicine of intracranial infections.

Methods: A total of 175 hospitalized patients presenting with suspected intracranial infections were selected for retrospective analysis. Base on the detection of responsible pathogens using CSF mNGS, the patients were categorized into two groups, responsible pathogens in Group A were detected but not in Group B. The types of responsible pathogens in group A and the final diagnosis of patients in group B were analyzed. Demographic data, clinical presentation, CSF analysis, imaging results, and electroencephalography (EEG) findings were analyzed for both groups. Finally, a scoring system was established to promptly assess the appropriateness of CSF mNGS for patients with suspected intracranial infections. Each independent predictor was assigned a score of 1, and the patients were subsequently scored. We advocate sending patients' CSF for mNGS when the cumulative score is ≥ 2.

Results: In Group A, the predominant responsible pathogen was the varicella-zoster virus (VZV), while Group B exhibited the highest proportion of final diagnoses related to epilepsy. The logistic regression model indicates that headache [OR = 2.982, 95% CI (1.204-7.383), p = 0.018], increased cerebrospinal fluid white cell count [OR = 4.022, 95% CI (1.331-12.156), p = 0.014], and decreased cerebrospinal fluid glucose levels [OR = 9.006, 95% CI (2.778-29.194), P < 0.001] are independent predictive factors for intracranial infection pathogens detected by CSF mNGS. Under this scoring system, the sensitivity for detecting the responsible pathogen was 57.5%, and the specificity was 87.4%.

Conclusion: The likelihood of detecting the responsible pathogen through CSF mNGS in patients with suspected intracranial infections can be evaluated using the scoring system. Furthermore, it is crucial to consider the possibility of another condition, such as epilepsy, when the responsible pathogen is not detected using cerebrospinal fluid mNGS.

探讨在拟颅内感染患者中实施 CSF mNGS 的适当情况。
背景:脑脊液(CSF)元基因组下一代测序(mNGS)是一种可靠的检测方法。然而,滥用这种方法可能会给患者和社会带来经济负担。本研究旨在探讨在疑似颅内感染患者中应用 CSF mNGS 的最佳条件,为颅内感染的精准医疗提供有价值的参考:方法:共选取 175 例疑似颅内感染的住院患者进行回顾性分析。根据 CSF mNGS 检测出的致病病原体,将患者分为两组,A 组检测出致病病原体,B 组未检测出致病病原体。分析了两组患者的人口统计学数据、临床表现、脑脊液分析、影像学结果和脑电图(EEG)结果。最后,建立了一套评分系统,用于及时评估 CSF mNGS 对疑似颅内感染患者的适宜性。每个独立的预测因子都被赋予 1 分,随后对患者进行评分。当累计得分≥2 分时,我们主张将患者的 CSF 送去进行 mNGS:结果:在 A 组中,主要病原体是水痘-带状疱疹病毒(VZV),而 B 组的最终诊断与癫痫相关的比例最高。逻辑回归模型显示,头痛[OR = 2.982,95% CI (1.204-7.383),P = 0.018]、脑脊液白细胞计数增高[OR = 4.022,95% CI (1.331-12.156),P = 0.014]和脑脊液葡萄糖水平降低[OR = 9.006,95% CI (2.778-29.194),P 结论:可使用评分系统评估疑似颅内感染患者通过脑脊液 mNGS 检测到病原体的可能性。此外,当使用脑脊液 mNGS 检测不到病原体时,考虑其他疾病(如癫痫)的可能性至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Neurology
BMC Neurology 医学-临床神经学
CiteScore
4.20
自引率
0.00%
发文量
428
审稿时长
3-8 weeks
期刊介绍: BMC Neurology is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of neurological disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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