Significance of metagenomic next-generation sequencing in the diagnosis and prognosis for spontaneous peritonitis in patients with cirrhosis

Abstract Background The most common infectious complication in patients with cirrhosis is spontaneous bacterial peritonitis (SBP), which is directly linked to the prognosis of patients with decompensated cirrhosis. The standard diagnostic criteria for SBP are insensitive, and early detection of SBP is difficult. Despite the evident benefits of metagenomic next-generation sequencing (mNGS) in the pathogens diagnosis of many infectious diseases, few data on the diagnosis and prognosis of SBP in patients with cirrhosis. Methods Sixty patients with cirrhotic ascites were enrolled from July 11, 2020, to December 15, 2020, who underwent ultrasound-guided abdominal puncture at Jilin University's First Hospital. Ascites samples of these patients were collected for mNGS detection and conventional pathogen culture. Patients were prospectively followed up on for 28 days and 90 days after enrolment. Finally, data on liver transplantation as well as other adverse events, death, and reasons for death were gathered prospectively in all patients 28 and 90 days after enrollment. Results Ascites mNGS technology can increase the positive rate of pathogens in cirrhotic patients with ascites when compared to ascites culture. The mNGS detection results are more detailed than ascites culture results, and they can help clinicians use antibiotics sooner. The positive rate of ascites PMN combined with ascites mNGS detection in the diagnosis of SBP in cirrhotic patients was significantly higher than that of ascites PMN combined with ascites culture. In cirrhotic patients with ascites, the mNGS assay was more accurate than the ascites culture in predicting adverse outcomes during the 28-dayand 90-day follow-up periods. Conclusions The ascites mNGS assay has greater diagnostic and prognostic value than bacterial culture for cirrhotic patients. In clinical practice, ascites mNGS detection should be conducted as soon as possible in patients with suspected SBP so that clinicians can identify and treat SBP earlier and improve prognosis.