Impact of Metagenomic Sequencing on Clinical Outcomes in Patients with Suspected Central Nervous System Infections: A Retrospective Case-Control Study

ObjectivesAlthough the value of metagenomic sequencing (mNGS) in diagnosing pathogens in central nervous system infections (CNSi) has been confirmed, its impact on the clinical outcomes of patients remains to be elucidated. This study intended to investigate the clinical impact of cerebrospinal fluid (CSF) mNGS on the outcomes of patients with suspected CNSi.MethodsBetween January 2022 and July 2024, patients who met both the inclusion and exclusion criteria were enrolled in the study and assigned to either the mNGS group (CSF tested by both mNGS and conventional microbiological tests [CMTs]) or the CMT group (CMTs alone). Following this, propensity score matching (PSM) was applied to balance baseline differences. The primary endpoint, time to clinical improvement, was then compared between the two groups and analyzed in stratified subgroups. Secondary endpoints included the rates of clinical improvement at 14 and 30 days, hospital stay, in-hospital mortality, and the proportion of GCS score <15.

研究目标：尽管宏基因组测序（metagenomic sequencing, mNGS）在中枢神经系统感染（central nervous system infections, CNSi）病原体诊断中的应用价值已得到证实，但其对患者临床结局的影响仍有待阐明。本研究旨在探讨脑脊液（cerebrospinal fluid, CSF）mNGS对疑似中枢神经系统感染患者临床结局的影响。
研究方法：2022年1月至2024年7月，纳入符合纳入及排除标准的患者，将其分配至mNGS组（脑脊液同时行mNGS与常规微生物检测（conventional microbiological tests, CMTs））或CMT组（仅行CMTs检测）。随后采用倾向得分匹配（propensity score matching, PSM）平衡两组患者的基线特征差异。主要终点为临床改善时间，随后对两组的该指标进行比较，并开展分层亚组分析。次要终点包括14天及30天临床改善率、住院时长、住院期间死亡率，以及格拉斯哥昏迷量表（Glasgow Coma Scale, GCS）评分＜15分的患者占比。