Laboratory markers included in the Corona Score can identify false negative results on COVID-19 RT-PCR in the emergency room

A Modified Corona Score Using Lung Ultrasound to Identify COVID-19 Patients

BACKGROUND

COVID-19 continues to circulate around the world with multiple different strains being active at once. While diagnosis with antigen and molecular testing is more readily available, there is still room for alternative methods of diagnosis, particularly in out-of-hospital settings, e.g., home or nursing homes, and in low-medium income countries, where testing may not be readily available.

STUDY OBJECTIVES

To evaluate the performance of two modified corona score methods compared with a traditional corona score approach to identify patients with COVID-19.

METHODS

This was a retrospective multicenter study performed to compare the ability to predict SARS-CoV-2 test results on a nasopharyngeal swab between the corona scores and two novel corona scores (modified 1 corona score (M1CS) and modified 2 corona score (M2CS)). The M1CS included lung ultrasound (LUS) and chest X-ray (CXR) results, while the M2SC only utilized LUS findings without CXRs. Emergency physicians performed point-of-care LUS and a physical examination upon admission to the emergency department.

RESULTS

Subjects positive for SARS-CoV-2 were older and had higher ferritin levels and temperature and lower diastolic blood pressure and oxygen saturation. The two groups differed on corona score and modified corona scores (p < 0.001 for all). SARS-CoV-2-positive patients had fewer pleural line irregularities (p = 0.025) but presented more frequently with an interstitial pattern on CXRs (p < 0.001).

CONCLUSIONS

In our study, LUS alone provided a valuable contribution to the corona score and improved its performance more than when CXR results were included. These results suggest that resource-limited areas where CXRs may be unavailable or prohibitively expensive can utilize an ultrasound as the sole imaging modality without a loss of diagnostic performance for SARS-CoV-2 pneumonia diagnosis.

High immature platelet fraction with reduced platelet count on hospital admission. Can it be useful for COVID-19 diagnosis?

Introduction

Health professions are heavily engaged facing the current threat of SARS‐CoV‐2 (COVID‐19). Although there are many diagnostic tools, an accurate and rapid laboratory procedure for diagnosing COVID‐19 is recommended. We focused on platelet parameters as the additional biomarkers for clinical diagnosis in patients presenting to the emergency department (ED).

Materials and Methods

Five hundred and sixty‐one patients from February to April 2020 have been recruited. Patients were divided into three groups: (N = 50) COVID‐19 positive and (N = 21) COVID‐19 negative with molecular testing, (N = 490) as reference population without molecular testing. A Multiplex rRT‐PCR from samples collected by nasopharyngeal swabs was performed and the hematological data collected.

Results

We detected a mild anemia in COVID‐19 group and lymphopenia against reference population: hemoglobin (g/dL) 13.0 (11.5‐14.8) versus 13.9 (12.8‐15.0) (P = .0135); lymphocytes (10⁹/L) 1.24 (0.94‐1.73) versus 1.99 (1.49‐2.64) (P < .0001). In addition, abnormal platelet parameters as follows (COVID group vs reference population): PLT (×10⁹/L) 209 (160‐258) vs 236 (193‐279) (P = .0239). IPF (%) 4.05 (2.5‐5.9) versus 3.4 (2.2‐4.9) (P = .0576); H‐IPF (%) 1.25 (0.8‐2.2) versus 0.95 (0.6‐1.5) (P = .0171) were identified. In particular, COVID positive group had a high H‐IPF/IPF Ratio compared to reference population [0.32 (0.29‐0.36) versus 0.29 (0.26‐0.32), respectively, (P = .0003)]. Finally, a PLT difference of nearly 50 × 10⁹/L between pre/postCOVID‐19 sampling for each patient was found (N = 42) (P = .0194).

Conclusions

COVID‐19 group results highlighted higher IPF and H‐IPF values, with increased H‐IPF/IPF Ratio, associated to PLT count reduction. These findings shall be adopted for a timely diagnosis of patients upon hospital admission.

A cross sectional evaluation of the corona-score for swift identification of SARS-CoV-2 infection at a tertiary care hospital in Pakistan

Background

The Corona-Score is one of the first and most widely used predictive model for coronavirus 2 (SARS-CoV-2) infection. The purpose of this study was to validate the performance of Corona-Score in a cohort of Pakistani patients pursuing care for suspected infection.

Methods

After seeking institution's ethical committee exemption, results of serum lactate dehydrogenase (LDH), C-reactive protein (CRP), ferritin, absolute lymphocyte and neutrophil counts, chest x-ray findings and demographics of suspected COVID-19 cases with respiratory symptoms were recouped from electronic medical record. The pre-validated score as proposed by Kurstjens S et al., was calculated. The subjects were divided into SARS-CoV-2 positive and negative on the basis of reverse transcription-polymerase chain reaction (RT-PCR) findings. Median and interquartile range (IQR) was calculated for the score in the two groups and the difference was assessed using the independent sample median test. Receiver operating characteristics (ROC) curve analysis was plotted. Statistical analyses were carried out using SPSS 26, with statistical significance set at p value < 0.05.

Results

A total of sixty cases, 30 (50%) RT-PCR positive and 30 (50%) negative with a median Corona-Score of 3.5 (IQR: 0-6) and 1.5 (IQR: 0-4) respectively, were evaluated. A p-value of 0.61 showing no statistically significant between group differences was observed. The area under the curve of Corona-Score in our population of patients was 0.59 (95% CI: 0.45-0.74). Using the cut-off values of four originally identified by Kurstjens et al. the model displayed 43.3% sensitivity and 70% specificity with an overall accuracy of 56.67%.

Conclusion

Corona-Score displayed a lower diagnostic accuracy which may be attributable to the different genetic framework, viral strain and severity of the disease in Pakistanis compared to the population where this score was originally validated. However, large multi-center studies across the country are dire need of time to evaluate the score in overly exhausted health care setup and limited availability of PCR testing.

Modified Corona Score can easily identify Covid-19 patients with gastrointestinal symptoms: An Italian proposal

AIM

We propose the Modified Corona Score (MCorona score), an alternative approach to identifying new likely Covid-19 patients without positive chest images, but with gastrointestinal onset.

BACKGROUND

In April, 2020, a total of 104,291 laboratory-confirmed cases had been documented in Italy; Lombardy, the Northern Italian Region, recorded over 60,000 Covid-19 cases.

METHOD

The MCorona score is built by several laboratory parameters linked between age and gender, ranging from 0 to 10.

RESULTS

Using the preliminary score cut-off of 4, we successfully identified likely Covid-19 patients with gastrointestinal onset. However, more caution is needed, and a larger sample size is required to verify the accuracy and specificity of the score.

CONCLUSION

We propose the complete validation of the MCorona score, an instrument able to diagnose likely Covid-19 patients with symptoms other than respiratory distress.