Background In this study, we aimed to perform a comprehensive analysis on the metagenomic next-generation sequencing for the etiological diagnosis of septic patients, and further to establish optimal read values for detecting common pathogens. Methods In this single-center retrospective study, septic patients who underwent pathogen detection by both microbial culture and metagenomic next-generation sequencing in the intensive care unit of the Second People’s Hospital of Shenzhen from June 24, 2015, to October 20, 2019, were included. Results A total of 193 patients with 305 detected specimens were included in the final analysis. The results of metagenomic next-generation sequencing showed significantly higher positive rates in samples from disparate loci, including blood, bronchoalveolar lavage fluid, and cerebrospinal fluid, as well as in the determination of various pathogens. The optimal diagnostic reads were 2893, 1825.5, and 892.5 for Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae, respectively. Conclusions The metagenomic next-generation sequencing is capable of identifying multiple pathogens in specimens from septic patients, and shows significantly higher positive rates than culture-based diagnostics. The optimal diagnostic reads for frequently detected microbes might be useful for the clinical application of metagenomic next-generation sequencing in terms of timely and accurately determining etiological pathogens for suspected and confirmed cases of sepsis due to well-performed data interpretation.

Background Complication of disseminated intravascular coagulation (DIC) is a determinant of the prognosis in patients with sepsis shock. Procalcitonin (PCT) has been advocated as a marker of bacterial sepsis. The purpose of this study was to evaluate the relationship between serum PCT levels and DIC with sepsis shock Methods A cohort study was designed which included patients that admitted in intensive care unit (ICU) between January 1, 2015 and December 31, 2018 and the follow-up to discharge. 164 septic shock patients were divided into DIC and non-DIC groups according to international society of thrombosis and homeostasis (ISTH). PCT was measured at the admission to ICU, and all the participants received routine biochemical coagulation test subsequently. Results PCT levels were considerably higher in septic shock patients who developed DIC than those who did not (54.6[13.6–200]vs12.6[2.4–53.3]ng/ml), respectively, P < 0.001). Multivariable logistic regression model revealed that PCT level was significantly associated with risk of DIC independent of conventional risk factors. In addition, curve fitting showed a linear relationship between PCT and DIC score. The Receiver Operating characteristic(ROC) curve suggested that the optimal cut-off point for PCT to predicting DIC induced by septic shock was 42.0 ng/ml, and the area under the curve (AUC) was 0.701(95% CI [0.619–0.784], P < 0.001). More importantly, incorporating PCT with other risk factors into the prediction model significantly increased the AUC for prediction of DIC induced by sepsis shock (0.801vs 0.706; P = 0.012). Conclusions Our study suggests that PCT levels on admission is significantly and independently associated with DIC development subsequently with septic shock, combining PCT levels with other risk factors could significantly improve the prediction of DIC induced by sepsis shock.

Objectives: To investigated the relationships between procalcitonin (PCT) and disseminated intravascular coagulation (DIC) during septic shock. Methods: A retrospective study was performed, which included septic shock patients admitted into intensive care unit (ICU) from January 1, 2015 to December 31, 2018. DIC was defined as international society of thrombosis and homeostasis criteria (ISTH≥5). PCT was based on the first value after admission into ICU and the routine biochemical coagulation data based on the worst value extracted from electronic medical records within 24 hours on admission into ICU.Results: Among 2156 patients screened, 164 patients with septic shock were included in the finally analysis and 35.4% (58/164) of whom developed DIC after admission. PCT level was significantly higher in septic shock patients who developed DIC than those who did not (54.6[13.6-200] vs12.6[2.4-53.3] ng/ml, P <0.001). Multivariable logistic regression revealed that PCT (OR=1.011, 95% CI 1.006- 1.016, P<0.001) was associated with DIC during septic shock. Curve fitting showed a positive correlation between PCT and DIC. The Receiver Operating characteristic (ROC) curve suggested that the cut-off point for PCT to predict DIC during septic shock was 42.1ng/ml, with sensitivity 60.34%, specificity72.74% and the area under the curve (AUC) 0.701(95% CI [0.619-0.784], P<0.001). Interestingly, PCT increased early detection of DIC during septic shock compared with other risk factors(P=0.012)Conclusions: Our data suggest that PCT level over 42.1ng/ml on admission is associated with DIC during septic shock, and PCT is a potential predictive factor of DIC induced by septic shock at early stage.