Metagenomics next-generation sequencing for the diagnosis of central nervous system infection: A systematic review and meta-analysis

Chunrun Qu; Yu Chen; Yuzhen Ouyang; Weicheng Huang; Fangkun Liu; Luzhe Yan; Ruoyu Lu; Yu Zeng; Zhixiong Liu

doi:10.3389/fneur.2022.989280

Metagenomics next-generation sequencing for the diagnosis of central nervous system infection: A systematic review and meta-analysis

Front Neurol. 2022 Sep 20:13:989280. doi: 10.3389/fneur.2022.989280. eCollection 2022.

Authors

Chunrun Qu^{1

2

3}, Yu Chen², Yuzhen Ouyang², Weicheng Huang², Fangkun Liu^{1

3}, Luzhe Yan², Ruoyu Lu², Yu Zeng^{1

3}, Zhixiong Liu^{1

3}

Affiliations

¹ Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.
² Xiangya School of Medicine, Central South University, Changsha, China.
³ National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.

Abstract

Objective: It is widely acknowledged that central nervous system (CNS) infection is a serious infectious disease accompanied by various complications. However, the accuracy of current detection methods is limited, leading to delayed diagnosis and treatment. In recent years, metagenomic next-generation sequencing (mNGS) has been increasingly adopted to improve the diagnostic yield. The present study sought to evaluate the value of mNGS in CNS infection diagnosis.

Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2022 guidelines, we searched relevant articles published in seven databases, including PubMed, Web of Science, and Cochrane Library, published from January 2014 to January 2022. High-quality articles related to mNGS applications in the CNS infection diagnosis were included. The comparison between mNGS and the gold standard of CNS infection, such as culture, PCR or serology, and microscopy, was conducted to obtain true positive (TP), true negative (TN), false positive (FP), and false negative (FN) values, which were extracted for sensitivity and specificity calculation.

Results: A total of 272 related studies were retrieved and strictly selected according to the inclusion and exclusion criteria. Finally, 12 studies were included for meta-analysis and the pooled sensitivity was 77% (95% CI: 70-82%, I ² = 39.69%) and specificity was 96% (95% CI: 93-98%, I ² = 72.07%). Although no significant heterogeneity in sensitivity was observed, a sub-group analysis was conducted based on the pathogen, region, age, and sample pretreatment method to ascertain potential confounders. The area under the curve (AUC) of the summary receiver operating characteristic curve (SROC) of mNGS for CNS infection was 0.91 (95% CI: 0.88-0.93). Besides, Deek's Funnel Plot Asymmetry Test indicated no publication bias in the included studies (Figure 3, p > 0.05).

Conclusion: Overall, mNGS exhibits good sensitivity and specificity for diagnosing CNS infection and diagnostic performance during clinical application by assisting in identifying the pathogen. However, the efficacy remains inconsistent, warranting subsequent studies for further performance improvement during its clinical application.

Study registration number: INPLASY202120002.

Keywords: central nervous system; diagnosis; infection; meta-analysis; metagenomic next-generation sequencing.

Publication types

Systematic Review