1. Bronchoalveolar lavage combined with metagenomics next-generation sequencing enhances the diagnostic and therapeutic efficacy of immune checkpoint inhibitor pneumonia: result from a prospective cohort study
- Author
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Zhenhua Zhou, Xintong Huang, Jiaxin Li, Jihong Huang, Lu Yuan, Wenxia Xie, Junyi Lu, Wenqi Huang, Shangwen He, Dong Yu, Hailin Zhang, Jian Guan, and Laiyu Liu
- Subjects
Public aspects of medicine ,RA1-1270 - Abstract
Background: Checkpoint Inhibitor Pneumonitis (CIP) poses a grave risk as a life-threatening complication defined by emerging lung infiltrates in cancer patients undergoing immune checkpoint inhibitor treatment. This study aims to investigate the value of bronchoalveolar lavage (BAL) combined with metagenomic next-generation sequencing (mNGS) in the diagnosis and precision treatment of CIP for providing evidence-based medicine. Methods: This study enrolled a total of 93 patients with Checkpoint Inhibitor Pneumonitis (CIP) from a prospective clinical cohort (NCT06192303), including 35 cases of pure-type CIP (PT-CIP) and 58 cases of mixed-type CIP (MT-CIP). Logistic regression analysis was employed to identify independent risk factors for mixed-type CIP and to construct a corresponding nomogram predictive model for MT-CIP. A comprehensive microbiota atlas was further used to display the microbiota characteristics of patients with different types of CIP. Additionally, we assessed the value of BAL combined with mNGS in guiding CIP treatment by comparing the 7-day effectiveness of treatment, the intensity of antibiotic use during hospitalization, the total time to relief to grade I or below, and the proportion of resolution within three months. Findings: Univariate and multivariate logistic regression analyses indicated that the history of COPD, dyspnea, CRP, and ALC are independent risk factors for mixed-type CIP. The area under the ROC curve (AUROC) of the MT-CIP prediction model, which was constructed based on clinical indicators and BAL mNGS results, reached 0.895 (95% CI: 0.805 – 0.985, Sensitivity: 0.871, Specificity: 0.9). BALF microbiota analysis suggested the potential of porphyromonas as a characteristic genus in mixed-type CIP, showing a significant negative correlation with Absolute Eosinophil Count (AEC) in the blood. The BAL mNGS group exhibited significantly higher efficacy rates at 7 days of treatment (90.2% vs 69.0%, P
- Published
- 2025
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