Characteristics and outcomes of clinically diagnosed RT-PCR swab negative COVID-19: a retrospective cohort study

AbstractPatients with strong clinical features of COVID-19 with negative real time polymerase chain reaction (RT-PCR) SARS-CoV-2 testing are not currently included in official statistics. The scale, characteristics and clinical relevance of this group are thus unknown. We performed a retrospective cohort study in two large London hospitals to characterize the demographic, clinical, and hospitalization outcome characteristics of swab-negative clinical COVID-19 patients. We found 1 in 5 patients with a negative swab and clinical suspicion of COVID-19 received a clinical diagnosis of COVID-19 within clinical documentation, discharge summary or death certificate. We compared this group to a similar swab positive cohort and found similar demographic composition, symptomology and laboratory findings. Swab-negative clinical COVID-19 patients had better outcomes, with shorter length of hospital stay, reduced need for >60% supplementary oxygen and reduced mortality. Patients with strong clinical features of COVID-19 that are swab-negative are a common clinical challenge. Health systems must recognize and plan for the management of swab-negative patients in their COVID-19 clinical management, infection control policies and epidemiological assessments.

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Characteristics and outcomes of clinically diagnosed RT-PCR swab negative COVID-19: a retrospective cohort study

Scientific Reports ◽

10.1038/s41598-021-81930-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Paul Middleton ◽

Pablo N. Perez-Guzman ◽

Alexandra Cheng ◽

Naveenta Kumar ◽

Mara D. Kont ◽

...

Keyword(s):

Cohort Study ◽

Clinical Features ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Length Of Hospital Stay ◽

Discharge Summary ◽

Rt Pcr ◽

Laboratory Findings ◽

Scale Characteristics ◽

Polymerase Chain

AbstractPatients with strong clinical features of COVID-19 with negative real time polymerase chain reaction (RT-PCR) SARS-CoV-2 testing are not currently included in official statistics. The scale, characteristics and clinical relevance of this group are not well described. We performed a retrospective cohort study in two large London hospitals to characterize the demographic, clinical, and hospitalization outcome characteristics of swab-negative clinical COVID-19 patients. We found 1 in 5 patients with a negative swab and clinical suspicion of COVID-19 received a clinical diagnosis of COVID-19 within clinical documentation, discharge summary or death certificate. We compared this group to a similar swab positive cohort and found similar demographic composition, symptomology and laboratory findings. Swab-negative clinical COVID-19 patients had better outcomes, with shorter length of hospital stay, reduced need for > 60% supplementary oxygen and reduced mortality. Patients with strong clinical features of COVID-19 that are swab-negative are a common clinical challenge. Health systems must recognize and plan for the management of swab-negative patients in their COVID-19 clinical management, infection control policies and epidemiological assessments.

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Factors associated with the time to return negative RT-PCR from COVID-19 in paediatric patients: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2021-052609 ◽

2021 ◽

Vol 11 (10) ◽

pp. e052609

Author(s):

Jianbo Shao ◽

Hong Xu ◽

Zhixi Liu ◽

Xiaohua Ying ◽

Hua Xu ◽

...

Keyword(s):

Cohort Study ◽

Outcome Measures ◽

Clinical Features ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Antiviral Drugs ◽

Secondary Outcome ◽

Rt Pcr ◽

Factors Associated ◽

Paediatric Patients

ObjectiveThis study aimed to describe the epidemiological and clinical features and potential factors related to the time to return negative reverse transcriptase (RT)-PCR in discharged paediatric patients with COVID-19.DesignRetrospective cohort study.SettingUnscheduled admissions to 12 tertiary hospitals in China.ParticipantsTwo hundred and thirty-three clinical charts of paediatric patients with confirmed diagnosis of COVID-19 admitted from 1 January 2020 to 17 April 2020.Primary and secondary outcome measuresPrimary outcome measures: factors associated with the time to return negative RT-PCR from COVID-19 in paediatric patients. Secondary outcome measures: epidemiological and clinical features and laboratory results in paediatric patients.ResultsThe median age of patients in our cohort was 7.50 (IQR: 2.92–12.17) years, and 133 (57.1%) patients were male. 42 (18.0%) patients were evaluated as asymptomatic, while 162 (69.5%) and 25 (10.7%) patients were classified as mild or moderate, respectively. In Cox regression analysis, longer time to negative RT-PCR was associated with the presence of confirmed infection in family members (HR (95% CI): 0.56 (0.41 to 0.79)). Paediatric patients with emesis symptom had a longer time to return negative (HR (95% CI): 0.33 (0.14 to 0.78)). During hospitalisation, the use of traditional Chinese medicine (TCM) and antiviral drugs at the same time is less conducive to return negative than antiviral drugs alone (HR (95% CI): 0.85 (0.64 to 1.13)).ConclusionsThe mode of transmission might be a critical factor determining the disease severity of COVID-19. Patients with emesis symptom, complications or confirmed infection in family members may have longer healing time than others. However, there were no significant favourable effects from TCM when the patients have received antiviral treatment.

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Survival patterns of COVID-19 pneumonia patients with false-negative PCR results transferred to the intensive care unit from the emergency department

10.21203/rs.3.rs-652047/v1 ◽

2021 ◽

Author(s):

Meltem Songur Kodik

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

False Negative ◽

Survival Rates ◽

Length Of Hospital Stay ◽

Treatment Modalities ◽

Laboratory Findings

Abstract ObjectiveThis study aimed to analyze factors associated with patient mortality in COVID-19 patients hospitalized in the intensive care unit (ICU) and provide data to help prioritize the most critical patients.DesignRetrospective cohort studySetting and participantsData for 289 patients were analyzed by the XXX hospital’s IT department.MethodsA clinical retrospective cohort study was conducted in a tertiary hospital. Patients (n=289) with negative reverse transcription-polymerase chain reaction (RT-PCR) and positive chest computed tomography (CT) scan indicating COVID-19 were included in the research. Demographics, clinical characteristics, treatment modalities, and length of hospital stay were analyzed in relation to 30-day survival outcomes.ResultsThe mean age of the patients was 69.04±15.10 years (range 19-100), and 41.2% (n=119) were female. The mortality rate was 48.1% (n=139). There were statistically significant differences in laboratory findings, such as hemoglobin (p=0.021), lymphocyte counts (p=0.046), d-dimer (p=0.009), and lactate (<0.001) regarding one-month survival. Additionally, those hospitalized for more than 5 days had higher one-month survival rates (hazard ratio (HR)= 0.003, CI= 10.264-155.972). Moreover, intubated patients had a higher mortality risk during this period (HR=4.15, CI=1.53-11.20).Conclusions and implicationsThe first five days of patients hospitalized in intensive care units due to COVID-19 pneumonia are critical. Besides, the need for intubation was another factor independently affecting survival. Clinicians should be alerted about the significance of these factors.

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Clinical features and outcomes of recalcitrant ulcers in diabetic foot patients: a retrospective cohort study

Endocrinology: News, Opinions, Training ◽

10.33029/2304-9529-2020-9-3-21-25 ◽

2020 ◽

Vol 9 (3) ◽

pp. 21-25

Author(s):

E.Yu. Komelyagina ◽

◽

M.B. Antsiferov ◽

Keyword(s):

Cohort Study ◽

Clinical Features ◽

Retrospective Cohort Study ◽

Diabetic Foot ◽

Retrospective Cohort

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Clinical Features and Outcome of Sickle Cell Disease in a Tertiary Center in Northern Lebanon: A Retrospective Cohort Study in a Local, Hospital-Associated Registry

Hemoglobin ◽

10.1080/03630269.2021.1904974 ◽

2021 ◽

pp. 1-7

Author(s):

Adlette Inati ◽

Chadi Al Alam ◽

Cristel El Ojaimi ◽

Taghrid Hamad ◽

Hemanth Kanakamedala ◽

...

Keyword(s):

Cohort Study ◽

Sickle Cell Disease ◽

Clinical Features ◽

Sickle Cell ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Cell Disease ◽

Local Hospital ◽

Tertiary Center

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Reinfection Rates Among Patients Who Previously Tested Positive for Coronavirus Disease 2019: A Retrospective Cohort Study

Clinical Infectious Diseases ◽

10.1093/cid/ciab234 ◽

2021 ◽

Author(s):

Megan M Sheehan ◽

Anita J Reddy ◽

Michael B Rothberg

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Symptomatic Infection ◽

Symptomatic Disease ◽

Viral Shedding ◽

History Of ◽

Polymerase Chain ◽

Prior Infection ◽

Over Time

Abstract Background Protection afforded from prior disease among patients with coronavirus disease 2019 (COVID-19) infection is unknown. If infection provides substantial long-lasting immunity, it may be appropriate to reconsider vaccination distribution. Methods This retrospective cohort study of 1 health system included 150 325 patients tested for COVID-19 infection via polymerase chain reaction from 12 March 2020 to 30 August 2020. Testing performed up to 24 February 2021 in these patients was included. The main outcome was reinfection, defined as infection ≥90 days after initial testing. Secondary outcomes were symptomatic infection and protection of prior infection against reinfection. Results Of 150 325 patients, 8845 (5.9%) tested positive and 141 480 (94.1%) tested negative before 30 August. A total of 1278 (14.4%) positive patients were retested after 90 days, and 62 had possible reinfection. Of those, 31 (50%) were symptomatic. Of those with initial negative testing, 5449 (3.9%) were subsequently positive and 3191 of those (58.5%) were symptomatic. Protection offered from prior infection was 81.8% (95% confidence interval [CI], 76.6–85.8) and against symptomatic infection was 84.5% (95% CI, 77.9–89.1). This protection increased over time. Conclusions Prior infection in patients with COVID-19 was highly protective against reinfection and symptomatic disease. This protection increased over time, suggesting that viral shedding or ongoing immune response may persist beyond 90 days and may not represent true reinfection. As vaccine supply is limited, patients with known history of COVID-19 could delay early vaccination to allow for the most vulnerable to access the vaccine and slow transmission.

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Clinical characteristics and outcome of influenza virus infection among adults hospitalized with severe COVID-19: a retrospective cohort study from Wuhan, China

BMC Infectious Diseases ◽

10.1186/s12879-021-05975-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xunliang Tong ◽

Xiaomao Xu ◽

Guoyue Lv ◽

He Wang ◽

Anqi Cheng ◽

...

Keyword(s):

Influenza Virus ◽

Cohort Study ◽

Clinical Features ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Cox Regression ◽

Influenza Virus Infection ◽

Chronic Respiratory Disease ◽

Hospital Death ◽

New City

Abstract Background Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that rapidly spreads worldwide and co-infection of COVID-19 and influenza may occur in some cases. We aimed to describe clinical features and outcomes of severe COVID-19 patients with co-infection of influenza virus. Methods Retrospective cohort study was performed and a total of 140 patients with severe COVID-19 were enrolled in designated wards of Sino-French New City Branch of Tongji Hospital between Feb 8th and March 15th in Wuhan city, Hubei province, China. The demographic, clinical features, laboratory indices, treatment and outcomes of these patients were collected. Results Of 140 severe COVID-19 hospitalized patients, including 73 patients (52.14%) with median age 62 years were influenza virus IgM-positive and 67 patients (47.86%) with median age 66 years were influenza virus IgM-negative. 76 (54.4%) of severe COVID-19 patients were males. Chronic comorbidities consisting mainly of hypertension (45.3%), diabetes (15.8%), chronic respiratory disease (7.2%), cardiovascular disease (5.8%), malignancy (4.3%) and chronic kidney disease (2.2%). Clinical features, including fever (≥38 °C), chill, cough, chest pain, dyspnea, diarrhea and fatigue or myalgia were collected. Fatigue or myalgia was less found in COVID-19 patients with IgM-positive (33.3% vs 50/7%, P = 0.0375). Higher proportion of prolonged activated partial thromboplastin time (APTT) > 42 s was observed in COVID-19 patients with influenza virus IgM-negative (43.8% vs 23.6%, P = 0.0127). Severe COVID-19 Patients with influenza virus IgM positive have a higher cumulative survivor rate than that of patients with influenza virus IgM negative (Log-rank P = 0.0308). Considering age is a potential confounding variable, difference in age was adjusted between different influenza virus IgM status groups, the HR was 0.29 (95% CI, 0.081–1.100). Similarly, difference in gender was adjusted as above, the HR was 0.262 (95% CI, 0.072–0.952) in the COX regression model. Conclusions Influenza virus IgM positive may be associated with decreasing in-hospital death.

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Influence of weekday of admission and level of distress on length of hospital stay in patients with low back pain: a retrospective cohort study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04529-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Emanuel Brunner ◽

André Meichtry ◽

Davy Vancampfort ◽

Reinhard Imoberdorf ◽

David Gisi ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Low Back Pain ◽

Back Pain ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Negative Binomial ◽

Length Of Hospital Stay ◽

Binomial Model ◽

Low Back

Abstract Background Low back pain (LBP) is often a complex problem requiring interdisciplinary management to address patients’ multidimensional needs. Providing inpatient care for patients with LBP in primary care hospitals is a challenge. In this setting, interdisciplinary LBP management is often unavailable during weekends. Delays in therapeutic procedures may result in a prolonged length of hospital stay (LoS). The impact of delays on LoS might be strongest in patients reporting high levels of psychological distress. Therefore, this study investigates the influence of weekday of admission and distress on LoS of inpatients with LBP. Methods This retrospective cohort study was conducted between 1 February 2019 and 31 January 2020. In part 1, a negative binomial model was fitted to LoS with weekday of admission as a predictor. In part 2, the same model included weekday of admission, distress level, and their interaction as covariates. Planned contrast was used in part 1 to estimate the difference in log-expected LoS between group 1 (admissions Friday/Saturday) and the reference group (admissions Sunday-Thursday). In part 2, the same contrast was used to estimate the corresponding difference in (per-unit) distress trends. Results We identified 173 patients with LBP. The mean LoS was 7.8 days (SD = 5.59). Patients admitted on Friday (mean LoS = 10.3) and Saturday (LoS = 10.6) had longer stays, but not those admitted on Sunday (LoS = 7.1). Analysis of the weekday effect and planned contrast showed that admission on Friday or Saturday was associated with a significant increase in LoS (log ratio = 0.42, 95% CI = 0.21 to 0.63). A total of 101 patients (58%) returned questionnaires, and complete data on distress were available from 86 patients (49%). According to the negative binomial model for LoS and the planned contrast, the distress effect on LoS was significantly influenced (difference in slopes = 0.816, 95% CI = 0.03 to 1.60) by dichotomic weekdays of admission (Friday/Saturday vs. Sunday-Thursday). Conclusions Delays in interdisciplinary LBP management over the weekend may prolong LoS. This may particularly affect patients reporting high levels of distress. Our study provides a platform to further explore whether interdisciplinary LBP management addressing patients’ multidimensional needs reduces LoS in primary care hospitals.

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