Clinical Application Value of Metagenome Next-Generation Sequencing (mNGS) in Pulmonary Diffuse Exudative Lesions: A Retrospective Study

<bold>Abstract</bold> <bold>Objective:</bold> This study aims to investigate the clinical application value of Metagenome Next-Generation Sequencing (mNGS) for pulmonary diffuse exudative lesions. <bold>Methods:</bold> The study included 136 cases with these lesions at Fujian Provincial Hospital from 01/2014 to 11/2021; 77 had mNGS pathogen tests. Based on the pathogen detection outcomes and clinical diagnoses, patients were categorized into an infection group (IG) and a non-infection group (NIG). A comparison was made between the diagnostic efficacy of the mNGS technique and traditional culture methods. Meanwhile, 59 patients clinically identified as having infectious pulmonary diffuse exudative lesions but who did not receive mNGS testing were designated as the non-NGS infection group (non-IG). A retrospective cohort study was conducted on patients in both the IG and non-IG, with a 30-day all-cause mortality endpoint used for follow-up. <bold>Outcomes:</bold> Compared to culture, mNGS had 35% higher sensitivity (80% vs 45.5%, P<0.001) with no significant specificity difference (77.3% vs 95.5%, P=0.185). IG patients had a 14.55% 30-day mortality rate, whereas non-IG had 37.29%, statistically significant (P<0.05). COX regression pointed to CURB-65 score ≥3 (HR=3.348, P=0.001) and cardiovascular disease (HR=2.473, P=0.026) as independent risk factors. mNGS testing emerged as an independent protective factor (HR=0.368, P=0.017). <bold>Conclusion:</bold> The utilization of mNGS for diagnosing diffuse infectious exudative pulmonary lesions notably boosts clinical detection sensitivity and diagnostic precision, while significantly guiding therapeutic choices for patients.