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

Respiratory Research

Bernhard Ulm¹  Tobias Lahmer²  Sebastian Rasch²  Matthias Treiber²  Roman Iakoubov²  Roland M. Schmid²  Silvia Würstle²  Alexander Herner²  Fabian Geisler²  Ulrich Mayr²  Simon Weidlich³  Jochen Schneider³  Christoph Spinner³  Kathrin Rothe⁴  Ulrike Protzer⁵  Hrvoje Mijočević⁵  Egon Burian⁶  Rickmer Braren⁶  Fabian Lohöfer⁶  Marcus R. Makowski⁶  Kurt Ulm⁷ 

[1] Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany;Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany;Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany;German Center for Infection Research (DZIF), partner site Munich, Munich, Germany;German Center for Infection Research (DZIF), partner site Munich, Munich, Germany;Institute for Medical Microbiology, Immunology and Hygiene, School of Medicine, Technical University of Munich, Munich, Germany;German Center for Infection Research (DZIF), partner site Munich, Munich, Germany;Institute for Virology, School of Medicine, Technical University of Munich, Munich, Germany;Institute for Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany;Institute for Medical Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany;

关键词: COVID-19;    SARS-CoV-2;    Serology;    Computed tomography;    Efficacy;    Accuracy;   

DOI  :  10.1186/s12931-021-01717-9

来源: Springer

【 摘 要 】

BackgroundIn 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.MethodsIgM/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.ResultsSeroconversion 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.ConclusionsApproximately 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.

【 授权许可】

CC BY