Diagnostic value of NGS in bronchoalveolar lavage fluid for pulmonary fungal infection

Abstract

Abstract Metagenomic sequencing (mNGS) has been approved to diagnose lung fungal diseases. However, the test performance of clinical mNGS has not been widely recognized. This study aims to evaluate the value of mNGS in the system of bronchoalveolar lavage fluid through the systematic evaluation of gathered analysis and related research. A total of 1113 patients (265 with proven or probable invasive fungal diseases), included in 6 studies, were analyzed. The pooled sensitivity, specificity, PLR, NLR, and diagnostic odds ratio were 0.89(95%CI, 0.75–0.96), 0.86 (95%CI, 0.78–0.91), 6.2 (95%CI, 4.0-9.6), 0.12 (95%CI, 0.05–0.32), and 50(95%CI, 15–163), respectively. The area under the summary receiver operating characteristic curve, with 95% confidence intervals, was 0.93(95%CI,0.90–0.95).The accuracy of the metagenomic sequencing (mNGS) is good, has certain clinical characteristics, can explain the results separately, and has the clinical value of early diagnosis of lung fungal infection. Purpose:This meta-analysis of randomized controlled trials aims to investigate the diagnostic utility and benefits of mNGS in comparison to conventional detection techniques for lung fungal infection in clinical patients. Patients and methods:A preliminary diagnosis of lung infection based on a patient's medical history, clinical symptoms, and imaging tests is a requirement for inclusion.Using the method of meta-analysis, the sensitivity, specificity, diagnostic odds ratio (OR), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of BAL-mNGS for identifying lung fungal illness were pooled. Results:6 studies involving a total of 1113 patients, 265 of whom had invasive fungal diseases that were proven or likely to have occurred, were examined. The diagnostic odds ratio, PLR, NLR, and diagnostic sensitivity were all pooled, and their respective values were 0.89 (95% CI, 0.75–0.96), 0.86 (95% CI, 0.78–0.91), 6.2 (95% CI, 4.0-9.6), 0.12 (95% CI, 0.05–0.32), and 50 (95% CI, 15–163). With 95% confidence intervals, the area under the summary receiver operating characteristic curve was 0.93 (95%CI, 0.90–0.95). Conclusion:The clinical value of metagenomic sequencing (mNGS) for the early diagnosis of lung fungal infection is that it is accurate, has specific clinical characteristics, can explain the results separately, and has clinical utility.