Metagenomics next generation sequencing for diagnosis of invasive fungal diseases in patients with hematological diseases

Abstract

Abstract PURPOSE: To investigate the clinical characteristics and risk factors of invasive fungal disease (IFD) in patients with hematological disorders. METHODS: From January 2022 to January 2023, seventy patients with blood diseases hospitalized at the Second Hospital of Nanjing who were suspected of infection with IFD underwent mNGS and fungal pathogen detection. The clinical characteristics and laboratory data of 32 fungal infected individuals (IFD group) and 38 non-IFD groups were compared. SPSS and R software were used for the statistical analysis of risk factors associated with IFD. RESULTS: Using the results of conventional fungal cultures as a “gold standard”, the sensitivity, specificity, positive predictive value, and negative predictive value of mNGS for the evaluation of fungal pathogen infections in patients with hematological disorders were found to be 100% (10/10), 63.3% (38/60), 31.3% (10/32), and 100% (38/38), respectively. Multivariate logistic regression analysis revealed six independent risk factors associated with IFD in patients with hematological disorders: CD4+T cell count < 400 cells/µL (odds ratio (OR)=7.43, p=3.79x10-4), elevated C-reactive protein (OR=3.71, p=0.01), elevated interleukin (IL)-6 (OR=6.5, p=2.93x10-4), elevated IL-10 (OR=3.03, p=0.041), hypoproteinemia (OR=7.04, p=0.025), and neutropenia persisting for >10 days (OR=3.03, p=0.002). CONCLUSION: mNGS has high sensitivity in detecting IFD in patients with hematological diseases. CD4+cell count below 400/ul, increased level of C-reactive protein, IL-6, and IL-10, hypoalbuminemia, and neutropenia lasting for more than 10 days are independent risk factors for IFD in patients with hematological diseases.