Diagnostic value of metagenomic next-generation sequencing in the etiologic diagnosis of severe pneumonia
Yu Jing
Zhao Jing
Fu Linlin
Cui Tongtong
Pan Wensen
Abstract：Objective To evaluate the clinical utility of metagenomic next-generation sequencing(mNGS)for etio-logic diagnosis in severe pneumonia and to compare its performance with conventional microbiological testing and serological assays.Methods We retrospectively included 127 patients with severe pneumonia admitted to the intensive care unit of the Department of Pulmonary and Critical Care Medicine Ⅱ,The Second Hospital of Hebei Medical University from February 2021 to October 2022;all underwent mNGS testing.Bronchoalveolar lavage fluid(BALF)was collected via flexible bronchos-copy.Samples underwent mNGS,conventional microbiology(smear,culture,and acid-fast staining),and serological testing(IgM panel for nine respiratory pathogens and PCR-based nucleic acid detection).Pathogen positivity rates and inter-method agreement were compared to assess the accuracy and timeliness of mNGS testing.Results The overall positivity rate of mNGS testing was 89.76％,significantly higher than that of conventional microbiology(63.78％)and serology testing(51.18％)(all P＜0.05).For bacterial detection,the mNGS positivity rate(71.65％)exceeded those of conventional microbiolo-gy(55.12％,P=0.006)and serology testing(10.24％,P＜0.001).For fungal detection,mNGS likewise outperformed conven-tional microbiology(62.99％vs.21.26％)and serology testing(11.81％),with all pairwise differences achieving statistical significance(all P＜0.001).In contrast,serology testing was superior to mNGS for detecting atypical pathogens(9.45％vs.2.36％,P=0.017).Agreement between mNGS and either conventional microbiology or serology testing was poor(Kappa＜0.4).For mixed infections,mNGS yielded a significantly higher positivity rate(65.35％)than conventional microbiology(11.81％)and serology testing(17.32％),with all pairwise differences achieving statistical significance(all P＜0.001).Conclu-sion mNGS demonstrates a high positivity rate and offers broad,rapid detection advantages for etiologic diagnosis in severe pneumonia,with particularly strong performance for bacterial and fungal pathogens and for identifying mixed infections.
Keywords：Severe pneumoniaMetagenomic next-generation sequencingEtiologic diagnosisDiagnostic value
Publication Date：2026-03-18
Online Publishing Date：2026-04-08(First online date of this platform, not the publication date of the document)
Pages：7( 316-322 )