Benutzer: Gast  Login
Titel:

SARS-CoV-2 serology increases diagnostic accuracy in CT-suspected, PCR-negative COVID-19 patients during pandemic.

Dokumenttyp:
Journal Article
Autor(en):
Schneider, Jochen; Mijočević, Hrvoje; Ulm, Kurt; Ulm, Bernhard; Weidlich, Simon; Würstle, Silvia; Rothe, Kathrin; Treiber, Matthias; Iakoubov, Roman; Mayr, Ulrich; Lahmer, Tobias; Rasch, Sebastian; Herner, Alexander; Burian, Egon; Lohöfer, Fabian; Braren, Rickmer; Makowski, Marcus R; Schmid, Roland M; Protzer, Ulrike; Spinner, Christoph; Geisler, Fabian
Abstract:
BACKGROUND: In the absence of PCR detection of SARS-CoV-2 RNA, accurate diagnosis of COVID-19 is challenging. Low-dose computed tomography (CT) detects pulmonary infiltrates with high sensitivity, but findings may be non-specific. This study assesses the diagnostic value of SARS-CoV-2 serology for patients with distinct CT features but negative PCR. METHODS: IgM/IgG chemiluminescent immunoassay was performed for 107 patients with confirmed (group A: PCR + ; CT ±) and 46 patients with suspected (group B: repetitive PCR-; CT +) COVID-19, admitted to a German university hospital during the pandemic's first wave. A standardized, in-house CT classification of radiological signs of a viral pneumonia was used to assess the probability of COVID-19. RESULTS: Seroconversion rates (SR) determined on day 5, 10, 15, 20 and 25 after symptom onset (SO) were 8%, 25%, 65%, 76% and 91% for group A, and 0%, 10%, 19%, 37% and 46% for group B, respectively; (p < 0.01). Compared to hospitalized patients with a non-complicated course (non-ICU patients), seroconversion tended to occur at lower frequency and delayed in patients on intensive care units. SR of patients with CT findings classified as high certainty for COVID-19 were 8%, 22%, 68%, 79% and 93% in group A, compared with 0%, 15%, 28%, 50% and 50% in group B (p < 0.01). SARS-CoV-2 serology established a definite diagnosis in 12/46 group B patients. In 88% (8/9) of patients with negative serology > 14 days after symptom onset (group B), clinico-radiological consensus reassessment revealed probable diagnoses other than COVID-19. Sensitivity of SARS-CoV-2 serology was superior to PCR > 17d after symptom onset. CONCLUSIONS: Approximately one-third of patients with distinct COVID-19 CT findings are tested negative for SARS-CoV-2 RNA by PCR rendering correct diagnosis difficult. Implementation of SARS-CoV-2 serology testing alongside current CT/PCR-based diagnostic algorithms improves discrimination between COVID-19-related and non-related pulmonary infiltrates in PCR negative patients. However, sensitivity of SARS-CoV-2 serology strongly depends on the time of testing and becomes superior to PCR after the 2nd week following symptom onset.
Zeitschriftentitel:
Respir Res
Jahr:
2021
Band / Volume:
22
Heft / Issue:
1
Volltext / DOI:
doi:10.1186/s12931-021-01717-9
PubMed:
http://view.ncbi.nlm.nih.gov/pubmed/33892720
Print-ISSN:
1465-9921
TUM Einrichtung:
II. Medizinische Klinik und Poliklinik (Gastroenterologie); Institut für Diagnostische und Interventionelle Radiologie; Institut für Medizinische Mikrobiologie, Immunologie und Hygiene; Institut für Virologie
 BibTeX