rRT-PCR Test Results Upon Admission Might Be Associated with Outcome in Hospitalized Chest CT-Positive COVID-19 Patients: A Provincial Retrospective Cohort with Active Follow-Up

Background: The coronavirus disease 2019 (COVID-19) pandemic imposed the most devastating challenge on healthcare systems worldwide. Iran was among the first countries that had to confront serious shortages in reverse-transcriptase-polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and ventilators availabilities throughout the COVID-19 outbreak. Objectives: This study aimed to investigate the clinical course of hospitalized COVID-19 patients with different real-time RT-PCR test results during the first three weeks of the outbreak in Qazvin province, Iran. Methods: In this retrospective cohort study, patients with a positive chest computed tomography (CT) scan for COVID-19 who were admitted to all 12 hospitals across Qazvin province, Iran, between February 20 and March 11, 2020, were included and followed up until March 27, 2020. A multivariate logistic regression model was applied to compare the independent associates of death among COVID-19 patients. Then, patients were categorized into six groups based on admission to the intensive care unit (ICU) and rRT-PCR test status (positive, negative, or no test). Also, multilevel logistic regression was used to compare the odds of surviving in each group against the reference group (PCR negative patients not-received ICU) to show if the rational allocation of ICU occurred while its capacity is limited. Results: In this study, we included 998 patients (57% male; median age: 54 years) with positive chest CT scan changes. Among them, 558 patients were examined with rRT-PCR test and 73.8% tested positive. Case fatality rate (CFR) was 20.68 and 7.53% among hospitalized patients with positive and negative tests, respectively. While only 5.2% of patients were admitted to the ICU, CFR outside ICU was 17.70 and 4.65% in patients with positive and negative results not admitted to the ICU, respectively. Conclusions: Total CFR in all hospitalized COVID-19 patients in Qazvin province during the first three weeks of the pandemic was 11.7%. Also, according to the results, the main risk factors included a positive rRT-PCR test, age more than 70 years, and having two or more comorbidities or just immunodeficiency disorders. Hence, the ICU admission criteria or prioritized ICU beds allocation should be considered with more emphasis on rRT-PCR results when the capacity of ICU beds is low.

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Association between rRT-PCR test results upon admission and outcome in hospitalized chest CT-Positive COVID-19 patients; a provincial retrospective cohort with active follow-up

10.1101/2020.04.21.20074641 ◽

2020 ◽

Cited By ~ 3

Author(s):

Saeed Nemati ◽

Hamid Reza Najari ◽

Anita Eftekharzadeh ◽

Amir Mohammad Kazemifar ◽

Ali Qandian ◽

...

Keyword(s):

Retrospective Cohort ◽

Case Fatality Rate ◽

Case Fatality ◽

Study Data ◽

Chest Ct ◽

Hospitalized Patients ◽

Multivariate Logistic Regression Model ◽

Fatality Rate ◽

Test Results ◽

Pcr Test

AbstractBackgroundThe Covid-19 pandemic imposed the most devastating challenge on healthcare systems worldwide. Iran was among the first countries that had to confront serious shortages in RT-PCR testing for SARS-CoV-2 and ventilators availabilities throughout the COVID-19 outbreak. This study aimed to investigate the clinical course of hospitalized COVID-19 patients with different rRT-PCR test results during the first 3 weeks of the outbreak in Qazvin province, Iran.MethodsFor this retrospective cohort study, data of hospitalized patients primarily diagnosed as having COVID-19 in all 12 centers across the whole Qazvin province during Feb 20-Mar 11, 2020 was analyzed. A multivariate logistic regression model was applied to assess the independent associates of death among COVID-19 patients.Results998 patients (57% male, median age 54 years) with positive chest CT-scan changes were included in this study. Among them, 558 patients were examined with rRT-PCR test and 73·8% tested positive. Case fatality rate was 20·68% and 7·53% among test-positive and test negative hospitalized patients, respectively. While only 5·2% of patients were ICU admitted, case fatality rates outside ICU were 17·70% and 4·65% in test-positive and test-negative non-ICU admitted patients, correspondingly. The independent associates of death were age ≥ 70 years, testing positive with rRT-PCR test, having immunodeficiency disorders and ICU admission.ConclusionsHospitalized COVID-19 patients with mild symptoms despite positive chest CT changes and major comorbidities were more probable to have negative rRT-PCR test result, hence lower case fatality rate and a more favorable outcome.

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DIAGNOSTIC ROLE OF CHEST CT USING CO-RADS CATEGORIZATION IN SARS-COV-2 INFECTION WITH EMPHASIS ON IMPACT OF CT IN PATIENTS WITH DELAYED OR NEGATIVE INITIAL RTPCR TEST

10.36106/ijar/9301921 ◽

2021 ◽

pp. 51-52

Author(s):

Tharani Putta ◽

Kaushik Deconda

Keyword(s):

Diagnostic Performance ◽

Virus Disease ◽

Vital Role ◽

Chest Ct ◽

Lung Involvement ◽

Test Results ◽

Rt Pcr ◽

Diagnostic Role ◽

Pcr Test

BACKGROUND AND OBJECTIVE: Role of chest CT in diagnosis of corona virus disease 2019 (COVID-19) has been controversial. The purpose of this study is to evaluate the diagnostic performance of chest CT when utilizing COVID-19 Reporting and Data System (CO-RADS). METHODOLOGY: Retrospective study including consecutive patients with positive SARS-CoV-2 RT-PCR test (initial or repeat test) and chest CT done in our institute between June and September 2020. Spectrum of CT ndings, CO-RADS score and 25 point CT severity score (CTSS) were recorded. RESULTS: A total of 300 consecutive patients with SARS-CoV-2 infection were included in the analysis. Out of the 168 patients who underwent CT prior to positive RT-PCR result, 125 (74.4%) had CO-RADS 3, 4 or 5 score on chest CT. 32 study patients (10.6%) had initial negative RT-PCR of which 24 (75%) had CO-RADS 4 or 5 score. Of the total patients with CO-RADS 3 to 5 score (227), 20 (8.8%) had severe lung involvement (CTSS 18-25), 83 (36.6%) had moderate lung involvement (CTSS 8-17) and 124 (54.6%) had mild lung involvement (CTSS 1-7). The mean CTSS was 7.9 with mean lobar score being higher in lower lobes (RLL=1.82, LLL=1.78) compared to the upper and middle lobes (RUL=1.61, RML=1.19, LUL=1.53). CONCLUSION:CT using CO-RADS scoring system has good diagnostic performance. In addition to assessing disease severity, it plays a vital role in triage of patients with suspected COVID-19 especially when there is limited availability of SARS-CoV-2 RT-PCR tests, delay in RT-PCR test results or in negative RT-PCR cases when there is high index of clinical suspicion.

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Assessing the effects of exposure to a SARS-CoV-2 re-positive patient in healthcare personnel

10.21203/rs.3.rs-74695/v1 ◽

2020 ◽

Author(s):

Yoshihiko Ogawa ◽

Koji Nishida ◽

Iwao Gohma ◽

Kei Kasahara ◽

Hisakazu Yano

Keyword(s):

Medical Center ◽

Ethics Committee ◽

Healthcare Personnel ◽

Test Results ◽

Negative Results ◽

Active Isolation ◽

Aerosol Exposure ◽

Contact Exposure ◽

Pcr Test

Abstract Objective: To evaluate whether patients with COVID-19 who have tested re-positive with the PCR test for the SARS-CoV-2 virus are infectious is a challenge in the current circumstances. A follow-up survey was conducted with healthcare personnel (HCP) who were exposed to a patient whose PCR test results for SARS-CoV-2 were re-positive 18 days after the initial confirmation of negative PCR results.Results: We studied a total of 15 HCP who had contact exposures (15/15) and aerosol exposures (7/15). None of them tested positive for IgG against SARS-CoV-2 on blood examination. None of them had any symptoms during 10 days of active isolation. All PCR tests conducted using the nasopharyngeal swabs collected from the HCP on day 10 were negative. No apparent infection was found in any of the HCP who had contact exposure with and/or aerosol exposure from the patient whose PCR test results for SARS-CoV-2 were re-positive 18 days after the initial confirmation of negative results of PCR tests for SARS-CoV-2.Trial Registration: No. 170, approved June 10th, 2020 by the ethics committee of Sakai City Medical Center.

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Diffusion Capacity Abnormalities for Carbon Monoxide in Patients with COVID-19 At Three-Month Follow-up

European Respiratory Journal ◽

10.1183/13993003.03677-2020 ◽

2021 ◽

pp. 2003677

Author(s):

Wei Qin ◽

Shi Chen ◽

Yunxia Zhang ◽

Fen Dong ◽

Zhu Zhang ◽

...

Keyword(s):

Carbon Monoxide ◽

Pulmonary Function ◽

Clinical Symptoms ◽

Pulmonary Function Tests ◽

Chest Ct ◽

Test Results ◽

Diffusion Capacity ◽

Impaired Lung Function ◽

Multivariable Regression

ObjectiveTo evaluate pulmonary function and clinical symptoms in coronavirus disease 2019 (COVID-19) survivors within 3 months after hospital discharge, and to identify risk factors associated with impaired lung function.Methods and materialCOVID-19 patients were prospectively followed up with pulmonary function tests and clinical characteristics for 3 months following discharge from a hospital in Wuhan, China between January and February 2020.Results647 patients were included. 87 (13%) patients presented with weakness, 63 (10%) with palpitation and 56 (9%) with dyspnea. Prevalences of the three symptoms were markedly higher in severe patients than non-severe patients (19% versus 10% for weakness, p=0.003; 14% versus 7% for palpitation, p=0.007; 12% versus 7% for dyspnea, p=0.014). Results of multivariable regression showed an increased odd in the ongoing symptoms among severe patients (OR: 1.7, 95%CI: 1.1–2.6, p=0.026) or patients with longer hospital stay (OR: 1.03, 95%CI: 1.00–1.05, p=0.041). Pulmonary function test results were available for 81 patients, including 41 non-severe and 40 severe patients. In this subgroup, 44 (54%) patients manifested abnormal diffusion capacity for carbon monoxide (DLCO) (68% severe versus 42% non-severe patients, p=0.019). Chest CT total severity score (TSS)>10.5 (OR: 10.4; 95%CI: 2.5–44.1; p=0.001) on admission and ARDS (OR: 4.6; 95%CI: 1.4–15.5; p=0.014) were significantly associated with impaired DLCO. Pulmonary interstitial damage may be associated with abnormal DLCO.ConclusionPulmonary function, particularly DLCO, declined in COVID-19 survivors. This decrease was associated with TSS of chest CT >10.5 and ARDS occurrence. Pulmonary interstitial damage might contribute to the imparied DLCO.

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How Did Radiologists’ Diagnostic Accuracy Have Changed in Covid-19 Pneumonia; a Single Centre Retrospective Study

10.22541/au.161219232.27702071/v1 ◽

2021 ◽

Author(s):

Ali Murat Koc ◽

Levent Altın ◽

Türker Acar ◽

Alpay Arı ◽

Zehra Hilal Adıbelli

Keyword(s):

Chest Ct ◽

Ct Scans ◽

Test Results ◽

Rt Pcr ◽

Educational Activities ◽

Admission Rates ◽

Interpretation Errors ◽

Concomitant Factors ◽

Level Of Experience ◽

Pcr Test

Aims Delay and false positivity in PCR test results have necessitated accurate chest CT reporting for management of patients with COVID-19 suspected symptoms. Pandemic related workload and level of experience on covid-dedicated chest CT scans might have effected diagnostic performance of on-call radiologists. The aim of this study is to reveal the interpretation errors in chest-CT reports of COVID-19 suspected patients admitted to the ER. Methods COVID-19 dedicated chest-CT scans which were performed between March and June 2020 were re-evaluated and compared with the former reports of these scans and PCR test results. CT scan results were classified into four groups. Parenchymal involvement ratios, radiology departments’ workload, COVID-19 related educational activities have examined. Results Out of 5721 Chest-CT scans, 783 CTs belonging to 664 patients (340 female, 324 male) were included to this study. RT-PCR test was positive in 398; negative in 385 cases. PCR positivity was found to be highest in “normal” and “typical for covid” groups whereas lowest in “atypical for covid” and “not covid” groups. 5-25% parenchymal involvement ratio was found in 84.2% of the cases. Regarding number of chest CT scans performed, radiologists’ workload have found to be increased six-folds compared to the same months of the former year. With the re-evaluation, a total of 145 IEs (18.5%) have been found. IEs were mostly precipitated in the first two months (88.3%) and mostly in “not covid” class (60%) regardless of PCR positivity. COVID-19 and radiology entitled educational activities along with the ER admission rates within the first two months of pandemic have seem to be related with the decline of IEs within time. Conclusion COVID-19 pandemic made a great impact on radiology departments with an inevitable burden of daily chest-CT reporting. This workload and concomitant factors have possible effects on diagnostic challenges in COVID-19 pneumonia.

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Spectrum of CT appearance and CT severity index of COVID-19 pulmonary infection in correlation with age, sex, and PCR test: an Iraqi experience

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00422-3 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Ammar Mosa Al-Mosawe ◽

Hiba mohammed Abdulwahid ◽

Noor Abbas Hummadi Fayadh

Keyword(s):

Ct Scan ◽

Severity Score ◽

Severity Index ◽

Chest Ct ◽

Male Gender ◽

Strong Positive Correlation ◽

Lung Involvement ◽

Test Results ◽

Pulmonary Changes ◽

Pcr Test

Abstract Background Since June 2020, an explosion in number of new COVID-19 patients has been reported in Iraq with a steady increment in new daily reported cases over the next 3 months. The limited number of PCR kits in the country and the increment in the number of new COVID-19 cases makes the role of CT scan examinations rising and becoming essential in aiding the health institutions in diagnosing and isolating infected patients and those in close contacts. This study will review the spectrum of CT pulmonary changes due to COVID-19 infection and estimate the CT severity score index and its relation to age, sex, and PCR test results. Results The ground glass opacities were the most common encountered pattern of pulmonary changes and were seen in (79%). There was strong positive correlation between higher CT severity score and male gender (p value = 0.0002, R2 = 0.9). Also, there was significant correlation of CT severity score and increasing age (p value less than 0.00018). Significant correlation was seen between CT scan percentage of lung involvement and positive PCR test results (p value = 0.001917), as the CT severity index is increasing, the PCR test is more likely to be positive. Conclusions Chest CT is an important and fast imaging tool for the diagnosis of COVID-19-infected patients especially in developing countries. In addition, chest CT can predict the disease severity by showing the percentage of lung involvement and hence give an idea about the prognosis of the disease. Higher CT severity score is significantly correlated with male gender, older age group patients and likely positive PCR test.

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Clinical characteristics and disease patterns of patients with relapsing polychondritis: a retrospective cohort

10.21203/rs.3.rs-1215228/v1 ◽

2021 ◽

Author(s):

Dong Wang ◽

Lujia Guan ◽

xin Dong ◽

Xiaofan Zhu ◽

Zhaohui Tong

Keyword(s):

Retrospective Cohort ◽

Pulmonary Infection ◽

Activity Index ◽

Relapsing Polychondritis ◽

Disease Activity Index ◽

Chest Ct ◽

Ocular Involvement ◽

Respiratory Involvement ◽

Disease Patterns

Abstract Background Relapsing polychondritis (RP) is a rare autoimmune disease affected various cartilage, Patients with tracheal cartilage involvement are different from other patients. The objectives of this study were to allocated RP patients into two subgroups by chest computed tomography (CT) and compare the clinical features and disease patterns of each group.Methods A retrospective cohort study collected RP patients hospitalized at the Beijing Chao-Yang Hospital between January 2012 - August 2021. Patients were divided into two groups: respiratory involvement group and non-respiratory involvement group according to chest CT.Results In our study, respiratory involvement found in 59.7% (n=43) patients, which had higher rate of costochondritis, fewer rate of Inflammatory eye disease and auricular chondritis than those in non-respiratory involvement. Compared with non-respiratory involvement subgroup, The incidence of pulmonary infection marginally increased and those inflammatory indexes except for CAR were significantly higher in respiratory involvement subgroup, further subgroup analysis found that there was no significant relationship between inflammatory indexes and pulmonary infection. Finally, 5 patients died during the follow-up in this cohort with a median follow-up time of 6 years (range 3-8 years).Conclusion 59.7% of patients had respiratory involvement according to chest CT findings in our cohort, which had a strong inverse relationship between respiratory and auricular, ocular involvement. Increase inflammatory indexes were not correlated with pulmonary infection, suggesting that patients with respiratory involvement had a higher disease activity index of RP. The probability of survival was not found significant in two subgroups.

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Screening COVID-19 with Chest CT in Preference to RT-PCR: Based on Mortality Analysis

10.21203/rs.3.rs-31338/v1 ◽

2020 ◽

Author(s):

Yuanlong Xie ◽

Minhao Wu ◽

Chong Zhang ◽

Yufan Zhu ◽

Kun Li ◽

...

Keyword(s):

Mortality Rate ◽

Virus Disease ◽

Chest Ct ◽

Test Results ◽

Rt Pcr ◽

Number Of Patients ◽

Significant Difference ◽

The Mean ◽

Mortality Analysis ◽

Pcr Test

Abstract Corona Virus Disease 2019 (COVID-19) became the outbreak of infectious diseases emergency worldwide. It remains unknown whether the RT-PCR test results was associated with the prognosis of COVID-19 patients or not. In this study, a total number of 495 patients with typical chest CT feature and symptom consistent with COVID-19 were retrospectively included from Jan 23, 2020 to Feb 26, 2020. 186 (37.58%), 32 (6.46%) and 277 (55.96%) COVID-19 patients had initial positive, suspected and negative RT-PCR results, respectively. The mean age was 58.55 years and 254(51.3%) were older than 60 years. 60.00% (297/495), 22.02% (109/495) and 17.98% (89/495) of COVID-19 patients were common, severe and critically type, respectively. There were no significant differences of age, gender, time from onset to hospitalization and severity classification in the patients with initial positive and negative RT-PCR result. The mortality rate of patients with positive and negative were 7.14% and 7.94%. Patients with initial negative or initial positive RT-PCR results had no significant difference of mortality rate (c2=4.079, p=0.130). The number of patients with lymphocyte ratios under the normal level was significantly larger in patients with initial negative RT-PCR results (59/92) compared with the patients with initial positive result (86/167), p=0.033. COVID-19 patients with positive or negative RT-PCR results had no significant difference in severity and mortality. Chest CT may be a more effective tool to screen COVID-19 in preference to RT-PCR.

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A follow-up study shows that recovered patients with re-positive PCR test in Wuhan may not be infectious

BMC Medicine ◽

10.1186/s12916-021-01954-1 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Xiaomin Wu ◽

Zengmiao Wang ◽

Zhenyu He ◽

Yapin Li ◽

Yating Wu ◽

...

Keyword(s):

Retrospective Study ◽

Close Contact ◽

Test Results ◽

Positive Polymerase Chain Reaction ◽

Polymerase Chain ◽

Basic Characteristics ◽

Epidemiological Characteristics ◽

Second Wave ◽

Pcr Test

Abstract Background Previous studies showed that recovered coronavirus disease 2019 (COVID-19) patients can have a subsequent positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after they are discharged from the hospital. Understanding the epidemiological characteristics of recovered COVID-19 patients who have a re-positive test is vital for preventing a second wave of COVID-19. Methods This retrospective study analyzed the epidemiological and clinical features of 20,280 COVID-19 patients from multiple centers in Wuhan who had a positive PCR test between December 31, 2019, and August 4, 2020. The RT-PCR test results for 4079 individuals who had close contact with the re-positive cases were also obtained. Results In total, 2466 (12.16%) of the 20,280 patients had a re-positive SARS-CoV-2 PCR test after they were discharged from the hospital, and 4079 individuals had close contact with members of this patient group. All of these 4079 individuals had a negative SARS-CoV-2 PCR test. Conclusions This retrospective study in Wuhan analyzed the basic characteristics of recovered COVID-19 patients with re-positive PCR test and found that these cases may not be infectious.

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