Effects of viral infection and microbial diversity on patients with sepsis: A retrospective study based on metagenomic next-generation sequencing

doi:10.5847/wjem.j.1920-8642.2021.01.005

Abstract

Abstract:

BACKGROUND: The study aims to investigate the performance of a metagenomic next-generation sequencing (NGS)-based diagnostic technique for the identification of potential bacterial and viral infections and effects of concomitant viral infection on the survival rate of intensive care unit (ICU) sepsis patients.

METHODS: A total of 74 ICU patients with sepsis who were admitted to our institution from February 1, 2018 to June 30, 2019 were enrolled. Separate blood samples were collected from patients for blood cultures and metagenomic NGS when the patients’ body temperature was higher than 38 °C. Patients’ demographic data, including gender, age, ICU duration, ICU scores, and laboratory results, were recorded. The correlations between pathogen types and sepsis severity and survival rate were evaluated.

RESULTS: NGS produced higher positive results (105 of 118; 88.98%) than blood cultures (18 of 118; 15.25%) over the whole study period. Concomitant viral infection correlated closely with sepsis severity and had the negative effect on the survival of patients with sepsis. However, correlation analysis indicated that the bacterial variety did not correlate with the severity of sepsis.

CONCLUSIONS: Concurrent viral load correlates closely with the severity of sepsis and the survival rate of the ICU sepsis patients. This suggests that prophylactic administration of antiviral drugs combined with antibiotics may be beneficial to ICU sepsis patients.

Key words: Sepsis, Metagenomic next-generation sequencing, Viral infections, Bacterial infections, Microbial diversity

Li-wei Duan, Jin-long Qu, Jian Wan, Yong-hua Xu, Yi Shan, Li-xue Wu, Jin-hao Zheng, Wei-wei Jiang, Qi-tong Chen, Yan Zhu, Jian Zhou, Wen-bo Yu, Lei Pei, Xi Song, Wen-fang Li, Zhao-fen Lin. Effects of viral infection and microbial diversity on patients with sepsis: A retrospective study based on metagenomic next-generation sequencing[J]. World Journal of Emergency Medicine, 2021, 12(1): 29-35.

Figures/Tables 4

Table 1

Table 2

Figure 1.

Figure 2.

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Parameters	Virus-negative group (n=37)	Virus-positive group (n=37)	P-value
Demographic data
Gender (male/female)	27/10	23/14	0.456
Age (years)	53.86±17.03	62.35±14.43	0.024
Duration of ICU (days)	24.62±28.05	39.11±28.18	0.030
ICU scores at admission
APACHE II score	16.51±6.93	22.22±5.75	<0.001
SOFA	6.35±3.23	8.24±2.22	0.004
Laboratory infection parameters
WBC (×10⁹/L)	14.69±6.85	12.54±7.18	0.191
Neutrophil (%)	85.97±6.82	82.75±17.67	0.304
Leukomonocyte (%)	8.14±4.20	7.93±5.57	0.857
Platelet (×10⁹/L)	174.08±83.50	199.46±153.52	0.380
Procalcitonin (ng/mL)	5.12±9.31	4.85±13.67	0.924
C-reactive protein (mg/L)	118.85±159.95	128.10±114.75	0.776
Lactic acid (g/L)	1.03±1.45	1.10±2.39	0.889

Parameters	β HR	95% CI for HR	P-value
Age	0.023	1.00 (1.00-1.00)	0.077
Sex	-0.831	0.44 (0.21-0.89)	0.023
WBC	0.054	1.10 (1.00-1.10)	0.028
Neutrophil	-0.002	1.00 (0.97-1.00)	0.910
Leukomonocyte	-0.052	0.95 (0.87-1.00)	0.230
Platelet	-0.001	1.00 (1.00-1.00)	0.380
Procalcitonin	-0.001	1.00 (1.00-1.00)	0.220
C-reactive protein	0.033	1.00 (1.00-1.10)	0.033
Lactic acid	0.211	1.20 (1.00-1.50)	0.023
APACHE II score	0.162	1.20 (1.10-1.20)	<0.001
SOFA	0.203	1.20 (1.10-1.40)	<0.001
Concomitant viral infection	0.981	2.70 (1.20-5.80)	0.014

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