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Leineweber TD, Ghathian K, Lisby JG, Friis-Hansen L, Afzal S, Ellermann-Eriksen S, Ma CMG, Cohen AS, Jørgensen RL, Hansen MB, Kamstrup PR, Larsen H, Steenhard N, Jensen CB, Kallemose T, Forsberg MW, Kirkby NS, Schneider UV. Evaluation of four laboratory-based high-throughput SARS-CoV-2 automated antigen tests compared to RT-PCR on nasal and oropharyngeal samples. J Clin Virol 2023; 164:105472. [PMID: 37178678 PMCID: PMC10152833 DOI: 10.1016/j.jcv.2023.105472] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The demand for RT-PCR testing has been unprecedented during the SARS-CoV-2 pandemic. Fully automated antigen tests (AAT) are less cumbersome than RT-PCR, but data on performance compared to RT-PCR are scarce. METHODS The study consists of two parts. A retrospective analytical part, comparing the performance of four different AAT on 100 negative and 204 RT-PCR positive deep oropharyngeal samples divided into four groups based on RT-PCR cycle of quantification levels. In the prospective clinical part, 206 individuals positive for and 199 individuals negative for SARS-CoV-2 were sampled from either the anterior nasal cavity (mid-turbinate) or by deep oropharyngeal swabs or both. The performance of AATs was compared to RT-PCR. RESULTS The overall analytical sensitivity of the AATs differed significantly from 42% (95% CI 35-49) to 60% (95% CI 53-67) with 100% analytical specificity. Clinical sensitivity of the AATs differed significantly from 26% (95% CI 20-32) to 88% (95% CI 84-93) with significant higher sensitivity for mid-turbinate nasal swabs compared to deep oropharyngeal swabs. Clinical specificity varied from 97% to 100%. CONCLUSION All AATs were highly specific for detection of SARS-CoV-2. Three of the four AATs were significantly more sensitive than the fourth AAT both in terms of analytical and clinical sensitivity. Anatomical test location significantly influenced the clinical sensitivity of AATs.
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Affiliation(s)
- Thomas Daell Leineweber
- Copenhagen University Hospital Hvidovre, Department of Clinical Microbiology, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Khaled Ghathian
- Copenhagen University Hospital Hvidovre, Department of Clinical Microbiology, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Jan Gorm Lisby
- Copenhagen University Hospital Hvidovre, Department of Clinical Microbiology, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Lennart Friis-Hansen
- Copenhagen University Hospital Bispebjerg and Frederiksberg, Department of Clinical Biochemistry, Nielsine Nielsens Vej 4B, 2400, Copenhagen, Denmark
| | - Shoaib Afzal
- Copenhagen University Hospital Herlev and Gentofte, Department of Clinical Biochemistry, Borgmester Ib Juuls Vej 52, 2730, Herlev, Denmark
| | - Svend Ellermann-Eriksen
- Aarhus University Hospital, Department of Clinical Microbiology, Palle Juul-Jensens Boulevard 99, Skejby, 8200, Aarhus N., Denmark
| | - Chih Man German Ma
- Copenhagen University Hospital Hvidovre, Department of Clinical Microbiology, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Arieh S Cohen
- Danish National Test Center, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen, Denmark
| | - Rikke Lind Jørgensen
- Copenhagen University Hospital Hvidovre, Department of Clinical Microbiology, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Matilde Bøgelund Hansen
- Copenhagen University Hospital Herlev and Gentofte, Department of Clinical Microbiology, Borgmester Ib Juuls Vej 52, 2730, Herlev, Denmark
| | - Pia Rørbæk Kamstrup
- Copenhagen University Hospital Herlev and Gentofte, Department of Clinical Biochemistry, Borgmester Ib Juuls Vej 52, 2730, Herlev, Denmark
| | - Helene Larsen
- Technical University of Denmark - DTU, Centre for Diagnostics Department of Health Technology, Henrik Dams Allé, 2800, Kgs Lyngby, Denmark
| | - Nina Steenhard
- Danish National Test Center, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen, Denmark
| | - Christel Barker Jensen
- Copenhagen University Hospital Hvidovre, Department of Clinical Microbiology, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Thomas Kallemose
- Copenhagen University Hospital Hvidovre, Department of Clinical Research, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Maria Wendelboe Forsberg
- Copenhagen University Hospital Hvidovre, Department of Clinical Microbiology, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Nikolai Søren Kirkby
- Rigshospitalet, Department of Clinical Microbiology, Henrik Harpestrengsvej 4A, 2100, Copenhagen, Denmark
| | - Uffe Vest Schneider
- Copenhagen University Hospital Hvidovre, Department of Clinical Microbiology, Kettegaard Alle 30, 2650, Hvidovre, Denmark.
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Schneider UV, Forsberg MW, Leineweber TD, Jensen CB, Ghathian K, Agergaard CN, Mortensen KK, Cohen A, Jørgensen CS, Larsen H, Hansen MB, Saleme U, Koch A, Kirkby NS, Kallemose T, Schaadt ML, Jensen FH, Jørgensen RL, Ma CMG, Steenhard N, Knudsen JD, Lisby JG. A nationwide analytical and clinical evaluation of 44 rapid antigen tests for SARS-CoV-2 compared to RT-qPCR. J Clin Virol 2022; 153:105214. [PMID: 35738151 PMCID: PMC9173826 DOI: 10.1016/j.jcv.2022.105214] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022]
Abstract
Background The SARS-CoV-2 pandemic has resulted in massive testing by Rapid Antigen Tests (RAT) without solid independent data regarding clinical performance being available. Thus, decision on purchase of a specific RAT may rely on manufacturer-provided data and limited peer-reviewed data. Methods This study consists of two parts. In the retrospective analytical part, 33 RAT from 25 manufacturers were compared to RT-PCR on 100 negative and 204 positive deep oropharyngeal cavity samples divided into four groups based on RT-PCR Cq levels. In the prospective clinical part, nearly 200 individuals positive for SARS-CoV-2 and nearly 200 individuals negative for SARS-CoV-2 by routine RT-PCR testing were retested within 72 h for each of 44 included RAT from 26 manufacturers applying RT-PCR as the reference method. Results The overall analytical sensitivity differed significantly between the 33 included RAT; from 2.5% (95% CI 0.5–4.8) to 42% (95% CI 35–49). All RAT presented analytical specificities of 100%. Likewise, the overall clinical sensitivity varied significantly between the 44 included RAT; from 2.5% (95% CI 0.5–4.8) to 94% (95% CI 91–97). All RAT presented clinical specificities between 98 and 100%. Conclusion The study presents analytical as well as clinical performance data for 44 commercially available RAT compared to the same RT-PCR test. The study enables identification of individual RAT that has significantly higher sensitivity than other included RAT and may aid decision makers in selecting between the included RAT. Funding The study was funded by a participant fee for each test and the Danish Regions.
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