Abstract
To evaluate the clinical utility of continuous dynamic testing using the Metagenomic Capture (MetaCAP) next-generation sequencing technique in severe acute pancreatitis (SAP) patients complicated by prolonged organ failure (Pro-OF). Methods A prospective analysis was conducted on 65 SAP patients with Pro-OF from Xiangya Hospital of Central South University and Hunan Medical College General Hospital between January 2024 and September 2025. All patients underwent weekly peripheral blood MetaCAP dynamic detection to assess its diagnostic efficacy and prognostic value. Results Among the 65 Pro-OF patients, a total of 101 blood MetaCAP tests were performed, with a positivity rate of 51.5% (52/101), significantly higher than the positivity rate of traditional blood culture (25.7%,P=0.005). The overall concordance rate between MetaCAP pathogen detection results and microbiological culture results from various sampling sites was 90.9%, with concordance rates of 85.2% and 67.9% for peripancreatic and respiratory specimens, respectively. When organ failure duration exceeded two weeks, the MetaCAP positivity rate surged from 27.5% to 61.1%, whereas white blood cell count, C-reactive protein, and procalcitonin levels showed no similar trends. In patients undergoing continuous MetaCAP dynamic monitoring, mortality was significantly higher in those with persistently positive results compared to those with persistently negative results (58.8% vs. 11.1%, P=0.036). Conclusions In patients with SAP, prolonged duration of organ failure is associated with an increased risk of bloodstream infection (BSI), predominantly originating from peripancreatic and respiratory infections. Continuous dynamic monitoring of blood samples using MetaCAP not only provides accurate guidance for clinical anti-infective therapy, but also holds significant prognostic value for SAP patients complicated with Pro-OF.
Key words
severe acute pancreatitis /
prolonged organ failure /
peripancreatic infection /
infection detection
Cite this article
Download Citations
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
［1］ Lytras D，Manes K，Triantopoulou C，et al. Persistent early organ failure: defining the high-risk group of patients with severe acute pancreatitis? ［J］. Pancreas，2008，36(3): 249-254. DOI: 10.1097/MPA.0b013e31815acb2c.
［2］ Shi N，Liu T，de la Iglesia-Garcia D，et al. Duration of organ failure impacts mortality in acute pancreatitis ［J］. Gut，2020，69(3): 604-605. DOI: 10.1136/gutjnl-2019-318241.
［3］ Werge M，Novovic S，Schmidt PN，et al. Infection increases mortality in necrotizing pancreatitis: A systematic review and Meta-analysis ［J］. Pancreatology，2016，16(5): 698-707. DOI:10.1016/j.pan.2016.07.004.
［4］ Shen D，Wang D，Ning C，et al. Prognostic factors of critical acute pancreatitis: A prospective cohort study ［J］. Dig Liver Dis，2019，51(11): 1580-1585. DOI: 10.1016/j.dld.2019.04.007.
［5］ Mofidi R，Suttie SA，Patil PV，et al. The value of procalcitonin at predicting the severity of acute pancreatitis and development of infected pancreatic necrosis: Systematic review ［J］. Surgery，2009，146(1): 72-81. DOI: 10.1016/j.surg.2009.02.013.
［6］ Li J，Chen Z，Li L，et al. Interleukin-6 is better than C-reactive protein for the prediction of infected pancreatic necrosis and mortality in patients with acute pancreatitis ［J］. Front Cell Infect Microbiol，2022，12: 933221.DOI: 10.3389/fcimb.2022.933221.
［7］ Ji L，Lv JC，Song ZF，et al. Risk factors of infected pancreatic necrosis secondary to severe acute pancreatitis ［J］. Hepatobiliary Pancreat Dis Int，2016，15(4): 428-433. DOI: 10.1016/s1499-3872(15)60043-1.
［8］ Li J，Lin C，Ning C，et al. Early-onset emphysematous pancreatitis indicates poor outcomes in patients with infected pancreatic necrosis ［J］. Dig Liver Dis，2022，54(11): 1527-1532. DOI: 10.1016/j.dld.2022.04.001.
［9］ Lin C，Bonsu A，Li J，et al. Application of metagenomic next-generation sequencing for suspected infected pancreatic necrosis ［J］. Pancreatology，2022，22(7): 864-870. DOI: 10.1016/j.pan.2022.07.006.
［10］ Shen D，Lin C，Hong X，et al. Diagnostic performance of plasma metagenomic next-generation sequencing for infected pancreatic necrosis: A prospective multicenter study ［J］. J Infect，2023，87(6): e104-e106. DOI: 10.1016/j.jinf.2023.10.014.
［11］ Lin C，Li J，Liu B，et al. Metagenomic next-generation sequencing，instead of procalcitonin，could guide antibiotic usage in patients with febrile acute necrotizing pancreatitis: A multicenter，prospective cohort study ［J］. Int J Surg，2024，110(5): 2721-2729. DOI: 10.1097/JS9.0000000000001162.
［12］ Hong D，Wang P，Zhang J，et al. Plasma metagenomic next-generation sequencing of microbial cell-free DNA detects pathogens in patients with suspected infected pancreatic necrosis ［J］. BMC Infect Dis，2022，22(1): 675. DOI: 10.1186/s12879-022-07662-2.
［13］ Samuel L. Direct-from-blood detection of pathogens: A review of technology and challenges［J］. J Clin Microbiol，2023，61(7): e0023121. DOI: 10.1128/jcm.00231-21.
［14］ Gu W，Miller S，Chiu CY. Clinical metagenomic next-generation sequencing for pathogen detection［J］. Annu Rev Pathol，2019，14:319-338.DOI:10.1146/annurev-pathmechdis-012418-012751.
［15］ Cai S，Yuan J，Li Y，et al. Etiological diagnostic performance of probe capture-based targeted next-generation sequencing in bloodstream infection ［J］. J Thorac Dis，2024，16(4): 2539-2549. DOI: 10.21037/jtd-24-400.
［16］ Mamanova L，Coffey AJ，Scott CE，et al. Target-enrichment strategies for next-generation sequencing ［J］. Nat Methods，2010，7(2): 111-118. DOI: 10.1038/nmeth.1419.
［17］ Pei XM，Yeung MHY，Wong NN，et al. Targeted sequencing approach and its clinical applications for the molecular diagnosis of human diseases ［J］. Cells，2023，12(3): 493. DOI: 10.3390/cells12030493.
［18］ Tenner S，Vege SS，Sheth SG，et al. American College of gastroenterology guidelines: Management of acute pancreatitis ［J］. Am J Gastroenterol，2024，119(3): 419-437. DOI: 10.14309/ajg.0000000000002645.
［19］ Dellinger EP，Forsmark CE，Layer P，et al. Determinant-based classification of acute pancreatitis severity: An international multidisciplinary consultation ［J］. Ann Surg，2012，256(6): 875-880. DOI: 10.1097/SLA.0b013e318256f778.
［20］ 郭蓉，黄耿文. 2024年美国胃肠病学会《急性胰腺炎诊治指南》更新解读 ［J］. 中国实用外科杂志，2024，44(11): 1254-1258. DOI: 10.19538/j.cjps.issn1005-2208.2024.11.13.
［21］ van Santvoort HC，Besselink MG，Bakker OJ，et al. A step-up approach or open necrosectomy for necrotizing pancreatitis ［J］. N Engl J Med，2010，362(16): 1491-1502. DOI: 10.1056/NEJMoa0908821.
［22］ Shen D，Ning C，Huang G，et al. Outcomes of infected pancreatic necrosis complicated with duodenal fistula in the era of minimally invasive techniques ［J］. Scand J Gastroenterol，2019，54(6): 766-772. DOI: 10.1080/00365521.2019.1619831.
［23］ 申鼎成，刘志勇，黄耿文，等. 微创入路腹膜后胰腺坏死组织清除术治疗感染性胰腺坏死的近期疗效 ［J］. 中国微创外科杂志，2018，18(3): 277-280. DOI: 10.7659/j.issn.1005-6947.2018.03.002.
［24］ 宁彩虹，朱帅，申鼎成，等. 开放胰腺坏死组织清除术治疗感染性胰腺坏死的适应证及临床价值分析 ［J］. 中国普通外科杂志，2020，29(9): 1105-1111. DOI: 10.7659/j.issn.1005-6947.2020.09.011.
［25］ 李非，黄铂涵，曹锋. 感染性胰腺坏死的微创外科处理策略、技术及评价［J］. 中国实用外科杂志, 2024, 44(5): 512-516. DOI: 10.19538/j.cjps.issn1005-2208.2024.05.05.
［26］ Ning C，Sun Z，Shen D，et al. Is contemporary open pancreatic necrosectomy still useful in the minimally invasive era? ［J］. Surgery，2024，175(5): 1394-1401. DOI: 10.1016/j.surg.2024.01.021.
［27］ Zhu S，Ning C，Sun Z，et al. Minimal access retroperitoneal pancreatic necrosectomy for infected pancreatic necrosis: A single-center of 15 years' experience ［J］. Surgery，2025，183: 109392. DOI: 10.1016/j.surg.2025.109392.
［28］ Guo Q，Li A，Xia Q，et al. The role of organ failure and infection in necrotizing pancreatitis: A prospective study ［J］. Ann Surg，2014，259(6): 1201-1207. DOI: 10.1097/SLA.0000000000000264.
［29］ Petrov MS，Shanbhag S，Chakraborty M，et al. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis ［J］. Gastroenterology，2010，139(3): 813-820. DOI: 10.1053/j.gastro.2010.06.010.
［30］ Garret C，Peron M，Reignier J，et al. Risk factors and outcomes of infected pancreatic necrosis: Retrospective cohort of 148 patients admitted to the ICU for acute pancreatitis ［J］. United European Gastroenterol J，2018，6(6): 910-918. DOI: 10.1177/2050640618764049.
［31］ Padhan RK，Jain S，Agarwal S，et al. Primary and secondary organ failures cause mortality differentially in acute pancreatitis and should be distinguished ［J］. Pancreas，2018，47(3): 302-307. DOI: 10.1097/MPA.0000000000000998.
［32］ 刘柏岐，李嘉荣，洪晓悦，等. 宏基因捕获法二代测序技术在感染性胰腺坏死病原学诊断中的价值 ［J］. 中国普通外科杂志，2024，33(9): 1481-1487. DOI: 10.7659/j.issn.1005-6947.2024.09.015.
