Diagnostic performance of metagenomic next-generation sequencing for Pneumocystis jirovecii pneumonia

Abstract

AbstractObjective Pneumocystis jirovecii pneumonia (PJP) can be a life-threatening opportunistic infection. We aimed to include eligible clinical studies to evaluate the diagnostic accuracy of metagenomic next-generation sequencing (mNGS) for PJP. Methods A comprehensive electronic literature search of Web of Knowledge, PubMed, Cochrane Library, CNKI, and Wanfang data was performed. Bivariate analysis was performed to calculate the pooled sensitivity, specificity, diagnostic odds ratio (DOR), the area under the summary receiver operator characteristic (SROC) curve and the Q-point value (Q*). Results The literature search resulted in 9 studies with a total of 1343 patients, including 418 cases diagnosed with PJP and 925 controls. The pooled sensitivity of mNGS for the diagnosis of PJP was 0.974 [95% confidence interval (CI), 0.953–0.987]. The pooled specificity was 0.943 (95% CI, 0.926–0.957), the pooled DOR was 431.58 (95% CI, 186.77-997.27), the area under the SROC curve was 0.987, and the Q* was 0.951. TheI2test showed no heterogeneity between studies. The Deek funnel test suggested no potential publication bias. Subgroup analyses indicated that the area under the SROC curve of mNGS for diagnosis of PJP in immunocompromised and non-HIV patients was 0.9852 and 0.979, respectively. Conclusions Current evidence indicates that mNGS exhibits excellent accuracy for the diagnosis of PJP. mNGS is a promising tool for assessment of PJP in immunocompromised and non-HIV patients.