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

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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The role of CT imaging for management of COVID-19 in epidemic area: early experience from a University Hospital

Insights into Imaging ◽

10.1186/s13244-020-00957-5 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Vikram rao Bollineni ◽

Koenraad Hans Nieboer ◽

Seema Döring ◽

Nico Buls ◽

Johan de Mey

Keyword(s):

Ct Scan ◽

Predictive Value ◽

Ct Imaging ◽

Chest Ct ◽

University Hospital ◽

Rt Pcr ◽

Ct Findings ◽

Epidemic Area ◽

Chest Ct Scan ◽

Pcr Test

Abstract Background To evaluate the clinical value of the chest CT scan compared to the reference standard real-time polymerase chain reaction (RT-PCR) in COVID-19 patients. Methods From March 29th to April 15th of 2020, a total of 240 patients with respiratory distress underwent both a low-dose chest CT scan and RT-PCR tests. The performance of chest CT in diagnosing COVID-19 was assessed with reference to the RT-PCR result. Two board-certified radiologists (mean 24 years of experience chest CT), blinded for the RT-PCR result, reviewed all scans and decided positive or negative chest CT findings by consensus. Results Out of 240 patients, 60% (144/240) had positive RT-PCR results and 89% (213/240) had a positive chest CT scans. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of chest CT in suggesting COVID-19 were 100% (95% CI: 97–100%, 144/240), 28% (95% CI: 19–38%, 27/240), 68% (95% CI: 65–70%) and 100%, respectively. The diagnostic accuracy of the chest CT suggesting COVID-19 was 71% (95% CI: 65–77%). Thirty-three patients with positive chest CT scan and negative RT-PCR test at baseline underwent repeat RT-PCR assay. In this subgroup, 21.2% (7/33) cases became RT-PCR positive. Conclusion Chest CT imaging has high sensitivity and high NPV for diagnosing COVID-19 and can be considered as an alternative primary screening tool for COVID-19 in epidemic areas. In addition, a negative RT-PCR test, but positive CT findings can still be suggestive of COVID-19 infection.

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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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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

SSRN Electronic Journal ◽

10.2139/ssrn.3572861 ◽

2020 ◽

Author(s):

Hamid Reza Najari ◽

Saeed Nemati ◽

Anita Eftekharzadeh ◽

Amir Mohammad Kazemifar ◽

Ali Qandian ◽

...

Keyword(s):

Retrospective Cohort ◽

Chest Ct ◽

Test Results ◽

Pcr Test

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The Diagnostic Value of CT scans in the Process of Diagnosing COVID-19 in medical Centers

Health Technology Assessment in Action ◽

10.18502/htaa.v4i1.5866 ◽

2021 ◽

Author(s):

Afshin Ostovar ◽

Elham Ehsani-Chimeh ◽

Zeinab Fakoorfard

Keyword(s):

Ct Scan ◽

Sensitivity And Specificity ◽

Clinical Decision Making ◽

Diagnostic Value ◽

Chest Ct ◽

Rapid Review ◽

Ct Scans ◽

Rt Pcr ◽

Medical Centers ◽

Pcr Test

Background: Coronavirus disease (COVID-19) has spread around the world since the beginning of 2020. The definitive diagnosis of COVID-19 is the RT-PCR laboratory test. However, because of low sensitivity, the chest CT scan has become important for the rapid diagnosis and clinical decision-making. Objectives: This study aims to define CT scan’ diagnostic value in diagnosing COVID-19 in medical centers. Methods: This study is a rapid health technology assessment (HTA) and had two major phases. In phase 1, a rapid review was done for defining the sensitivity and specificity rate of CT. During this phase, studies related to the diagnostic and technical data on the use of CT in the diagnosis of COVID-19 were reviewed, and the sensitivity and specificity of CT in these studies were extracted. In phase 2, sequential testing was run to evaluate the diagnostic value of chest CT to diagnose COVID-19 according to two scenarios before and after adding RT-PCR test results. Results: CT scan has a high sensitivity for diagnosing cases of COVID-19. Due to its low specificity, relying on CT scans to diagnose COVID-19 alone in medical centers can lead to a significant proportion of false-positive cases. This study showed that if the probability of COVID-19 before the CT scan were about 50%, with a positive CT scan, this probability would be between 60 and 70% depending on the CT specificity. Conclusions: With the available evidence, the use of a CT scan alone is not sufficient for diagnosis. The RT-PCR test is also necessary to improve the diagnosis and continue the treatment and isolation of patients.

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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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Can initial chest CT scan predict status and clinical outcomes of COVID-19 infection? A retrospective cohort study

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00538-6 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Iman Abdollahi ◽

Mehrdad Nabahati ◽

Mostafa Javanian ◽

Hoda Shirafkan ◽

Rahele Mehraeen

Keyword(s):

Cohort Study ◽

Ct Scan ◽

Disease Severity ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Severe Disease ◽

Chest Ct ◽

Rt Pcr ◽

Icu Admission ◽

Chest Ct Scan

Abstract Background We aimed to investigate the association of initial chest CT scan findings with status and adverse outcomes of COVID-19 (including ICU admission, mortality, and disease severity). This retrospective cohort study was performed in three hospitals in Babol, northern Iran, between February and March 2020. Cases were confirmed by real-time polymerase chain reaction (RT-PCR). Clinical and paraclinical data of the patients were collected from their medical records. CT severity score (CSS) was calculated by a senior radiologist. Disease severity was determined based on the World Health Organization criteria. Results In total, 742 patients were included, of whom 451 (60.8%) were males and 291 (39.2%) were females. The mean age was 56.59 ± 14.88 years old. Also, 523 (70.5%) were RT-PCR-positive. Ground glass opacity was directly associated with RT-PCR positivity (odds ratio [OR] = 2.07). Also, RT-PCR-positive cases had significantly a higher CSS than RT-PCR-negative cases (p = 0.037). In patients confirmed with COVID-19, peribronchovascular distribution of lesions, number of zones involved, and CSS were associated with increased risk of ICU admission (OR = 2.93, OR = 2.10, and OR = 1.14, respectively), mortality (OR = 2.30, OR = 1.35, and OR=1.08, respectively), severe disease (OR = 2.06, OR = 1.68, and OR = 1.10, respectively), and critical disease (OR = 4.62, OR = 3.21, and OR = 1.23, respectively). Also, patients who had consolidation were at a higher risk of severe disease compared with those who did not (OR = 4.94). Conclusion Initial chest CT scan can predict COVID-19 positivity, ICU admission, mortality, and disease severity, specifically through CSS.

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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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Chest CT features of COVID-19 in the region of Abu Dhabi, UAE- A single institute study

10.1101/2020.11.14.20229096 ◽

2020 ◽

Author(s):

Ghufran Aref Saeed ◽

Abeer Ahmed Al Helali ◽

Safaa Almazrouei ◽

Asad Shah ◽

Luai A. Ahmed

Keyword(s):

Ct Scan ◽

Diagnostic Performance ◽

Chest Ct ◽

Abu Dhabi ◽

Ground Glass ◽

Rt Pcr ◽

Negative Results ◽

Chest Ct Scan ◽

Ct Features ◽

Pcr Test

AbstractOBJECTIVEOur aim is to investigate high resolution CT features of COVID-19 infection in Abu Dhabi, UAE, and to compare the diagnostic performance of CT scan with RT-PCR test.METHODSData of consecutive patients who were suspected to have COVID-19 infection and presented to our hospital, was collected from March 2, 2020, until April 12, 2020. All patients underwent RT-PCR test; out of which 53.8% had chest CT scan done. Using RT-PCR as a standard reference, the sensitivity and specify of CT scan was calculated. We also analyzed the most common imaging findings in patients with positive RT-PCR results.RESULTSThe typical HRCT findings were seen in 50 scans (65.8%) out of total positive ones; 44 (77.2%) with positive RT-PCR results and 6 (31.6%) with negative results. The peripheral disease distribution was seen in 86%, multilobe involvement in 70%, bilateral in 82%, and posterior in 82% of the 50 scans.The ground glass opacities were seen in 50/74 (89.3%) of positive RT-PCR group. The recognized GGO patterns in these scans were: rounded 50%, linear 38%, and crazy-paving 24%.Using RT-PCR as a standard of reference, chest HRCT scan revealed sensitivity of 68.8% and specificity of 70%.CONCLUSIONThe commonest HRCT findings in patients with COVID-19 pneumonia were peripheral, posterior, bilateral, multilobe rounded ground glass opacities.

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