Impact of Metagenomic Next-Generation Sequencing on Antimicrobial Optimization, Clinical Prognosis, and Cost-Effectiveness in Sepsis

Corresponding author: Zhao Yong, yfy153678@fy.ahmu.edu.cn

DOI: 10.12201/bmr.202603.00021

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  Abstract: Objective To evaluate the clinical decision-making value and health economic benefits of metagenomic next-generation sequencing (mNGS) in the diagnosis and treatment of sepsis, addressing the controversy of its high cost and low benefit based on real-world data. Methods The clinical data of 316 patients with sepsis admitted to The First Affiliated Hospital of Anhui Medical University from January to December 2023 were retrospectively analyzed. Patients were divided into an mNGS group (n=177) and a non-mNGS group (n=139) based on whether mNGS testing was performed. Generalized linear models (GLM) and multivariate logistic regression were used to adjust for confounding factors to analyze the impact of mNGS on treatment decisions, 28-day mortality, and medical costs. Results The baseline condition of the mNGS group was more critical; the intensive care unit (ICU) admission rate (67.2%) and sequential organ failure assessment (SOFA) scores were higher than those of the non-mNGS group, with the differences being statistically significant (P < 0.001). The positive detection rate of mNGS was 81.9%, which guided the optimization of antimicrobial agents in 62.7% of positive-matched patients, of which 86.5% were treatment escalations. However, after adjusting for disease severity, mNGS did not improve the 28-day survival rate (adjusted OR = 1.974, P = 0.077). The GLM model confirmed that ICU admission and mechanical ventilation were the main drivers of costs, and the adjusted per capita medical cost in the mNGS group increased by 7 057 RMB. Conclusion Under the current salvage use mode in late stages, the mNGS strategy incurs higher costs without survival benefits, making it an economically dominated scheme. Improving survival rates through early intervention is expected to improve its cost-effectiveness ratio.

  Key words: Metagenomic next-generation sequencing / Sepsis / Antimicrobial optimization / Cost-effectiveness analysis / Indication bias

  Submit time: 9 March 2026

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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  1	2026-02-23	10.12201/bmr.202603.00021V1	Download

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