Digestive diseases and sciences · 2025
Diagnostic Performance of Metagenomic Next-Generation Sequencing (mNGS) and Culture in Infected Pancreatic Necrosis: A Systematic Review and Meta-Analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Ali Aizaz, Khattak Asad Iqbal, Chawla Dikshit, Hasan Fariha, Khan Hafsa, Ali Muhammad Abdullah, Moeez Abdul, Tanveer Sana, Ubaidullah, Afridi Muhammad Jibran, Ikram Jibran, Hayat Saad, Shah Fatima Zehra, Nadeem Ahmed, Nadeem Muhammad Ahmad, Mushtaq Ali, Haroon Waqqas, Bharadwaj Hareesha Rishab, Dahiya Dushyant Singh, Mansoor Emad
Аннотация
BACKGROUND: Infected pancreatic necrosis (IPN) is a severe complication of acute pancreatitis, requiring prompt diagnosis. Conventional microbial culture, the current gold standard, has limitations in sensitivity and turnaround time. Metagenomic next-generation sequencing (mNGS) offers rapid, comprehensive pathogen detection, but its diagnostic performance for IPN remains unclear.
METHODS: We conducted a systematic review and meta-analysis following PRISMA-DTA guidelines, prospectively registered in PROSPERO (CRD420251008574). PubMed, Embase, and Web of Science databases were searched from inception to March 2025. Seven studies (313 patients) evaluating mNGS for IPN diagnosis were included, with four providing direct comparisons to culture. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated using a random-effects model. Heterogeneity was assessed using I2 statistics.
RESULTS: In double-arm analysis, mNGS showed significantly higher sensitivity (0.87, 95% CI: 0.72-0.95) than culture (0.36, 95% CI: 0.23-0.51), with comparable specificity (0.83 for both). The AUC for mNGS (0.92, 95% CI: 0.79-0.94) surpassed that of culture (0.52, 95% CI: 0.27-0.86). Single-arm analysis confirmed mNGS as a reliable standalone test (sensitivity: 0.86; specificity: 0.85; AUC: 0.89). A threshold effect (r = - 0.991) indicated variability in diagnostic criteria across studies.
CONCLUSIONS: mNGS outperforms culture in diagnosing IPN, offering higher sensitivity and faster results. Its ability to detect diverse pathogens, including fastidious and polymicrobial infections, makes it a valuable tool for early intervention. However, challenges like cost, standardization, and interpretation persist. Future studies should focus on prospective validation and cost-effectiveness to integrate mNGS into routine clinical practice.
METHODS: We conducted a systematic review and meta-analysis following PRISMA-DTA guidelines, prospectively registered in PROSPERO (CRD420251008574). PubMed, Embase, and Web of Science databases were searched from inception to March 2025. Seven studies (313 patients) evaluating mNGS for IPN diagnosis were included, with four providing direct comparisons to culture. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated using a random-effects model. Heterogeneity was assessed using I2 statistics.
RESULTS: In double-arm analysis, mNGS showed significantly higher sensitivity (0.87, 95% CI: 0.72-0.95) than culture (0.36, 95% CI: 0.23-0.51), with comparable specificity (0.83 for both). The AUC for mNGS (0.92, 95% CI: 0.79-0.94) surpassed that of culture (0.52, 95% CI: 0.27-0.86). Single-arm analysis confirmed mNGS as a reliable standalone test (sensitivity: 0.86; specificity: 0.85; AUC: 0.89). A threshold effect (r = - 0.991) indicated variability in diagnostic criteria across studies.
CONCLUSIONS: mNGS outperforms culture in diagnosing IPN, offering higher sensitivity and faster results. Its ability to detect diverse pathogens, including fastidious and polymicrobial infections, makes it a valuable tool for early intervention. However, challenges like cost, standardization, and interpretation persist. Future studies should focus on prospective validation and cost-effectiveness to integrate mNGS into routine clinical practice.