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Martinez-Fierro ML, González-Fuentes C, Cid-Guerrero D, González Delgado S, Carrillo-Martínez S, Gutierrez-Vela EF, Calzada-Luévano JY, Rocha-Pizaña MR, Martínez-Rendón J, Castañeda-López ME, Garza-Veloz I. Radiological Findings Increased the Successful of COVID-19 Diagnosis in Hospitalized Patients Suspected of Respiratory Viral Infection but with a Negative First SARS-CoV-2 RT-PCR Result. Diagnostics (Basel) 2022; 12:687. [PMID: 35328241 PMCID: PMC8946968 DOI: 10.3390/diagnostics12030687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/05/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023] Open
Abstract
SARS-CoV-2 is the etiological agent of COVID-19 and may evolve from asymptomatic disease to fatal outcomes. Real-time reverse-transcription polymerase chain reaction (RT-PCR) screening is the gold standard to diagnose severe accurate respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but this test is not 100% accurate, as false negatives can occur. We aimed to evaluate the potential false-negative results in hospitalized patients suspected of viral respiratory disease but with a negative previous SARS-CoV-2 RT-PCR and analyze variables that may increase the success of COVID-19 diagnosis in this group of patients. A total of 55 hospitalized patients suspected of viral respiratory disease but with a previous negative RT-PCR result for SARS-CoV-2 were included. All the participants had clinical findings related to COVID-19 and underwent a second SARS-CoV-2 RT-PCR. Chest-computed axial tomography (CT) was used as an auxiliary tool for COVID-19 diagnosis. After the second test, 36 patients (65.5%) were positive for SARS-CoV-2 (COVID-19 group), and 19 patients (34.5%) were negative (controls). There were differences between the groups in the platelet count and the levels of D-dimer, procalcitonin, and glucose (p < 0.05). Chest CT scans categorized as COVID-19 Reporting and Data System 5 (CO-RADS 5) were more frequent in the COVID-19 group than in the control group (91.7% vs. 52.6%; p = 0.003). CO-RADS 5 remained an independent predictor of COVID-19 diagnosis in a second SARS-CoV-2 screening (p = 0.013; odds ratio = 7.0, 95% confidence interval 1.5−32.7). In conclusion, chest CT classified as CO-RADS 5 was an independent predictor of a positive second SARS-CoV-2 RT-PCR, increasing the odds of COVID-19 diagnosis by seven times. Based on our results, in hospitalized patients with a chest CT classified as CO-RADS 5, a second SARS-CoV-2 RT-PCR test should be mandatory when the first one is negative. This approach could increase SARS-CoV-2 detection up to 65% and could allow for isolation and treatment, thus improving the patient outcome and avoiding further contagion.
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Affiliation(s)
- Margarita L Martinez-Fierro
- Molecular Medicine Laboratory, Unidad Académica de Medicina Humana y Ciencias de la Salud, Universidad Autónoma de Zacatecas, Zacatecas 98160, Mexico; (C.G.-F.); (S.G.D.); (S.C.-M.); (J.Y.C.-L.); (J.M.-R.); (M.E.C.-L.)
| | - Carolina González-Fuentes
- Molecular Medicine Laboratory, Unidad Académica de Medicina Humana y Ciencias de la Salud, Universidad Autónoma de Zacatecas, Zacatecas 98160, Mexico; (C.G.-F.); (S.G.D.); (S.C.-M.); (J.Y.C.-L.); (J.M.-R.); (M.E.C.-L.)
- Hospital General “Luz González Cosío”, Circuito Ciudad Gobierno, Zacatecas 98160, Mexico; (D.C.-G.); (E.F.G.-V.)
| | - Dagoberto Cid-Guerrero
- Hospital General “Luz González Cosío”, Circuito Ciudad Gobierno, Zacatecas 98160, Mexico; (D.C.-G.); (E.F.G.-V.)
| | - Samantha González Delgado
- Molecular Medicine Laboratory, Unidad Académica de Medicina Humana y Ciencias de la Salud, Universidad Autónoma de Zacatecas, Zacatecas 98160, Mexico; (C.G.-F.); (S.G.D.); (S.C.-M.); (J.Y.C.-L.); (J.M.-R.); (M.E.C.-L.)
| | - Santiago Carrillo-Martínez
- Molecular Medicine Laboratory, Unidad Académica de Medicina Humana y Ciencias de la Salud, Universidad Autónoma de Zacatecas, Zacatecas 98160, Mexico; (C.G.-F.); (S.G.D.); (S.C.-M.); (J.Y.C.-L.); (J.M.-R.); (M.E.C.-L.)
- Hospital General “Luz González Cosío”, Circuito Ciudad Gobierno, Zacatecas 98160, Mexico; (D.C.-G.); (E.F.G.-V.)
| | | | - Juan Yadid Calzada-Luévano
- Molecular Medicine Laboratory, Unidad Académica de Medicina Humana y Ciencias de la Salud, Universidad Autónoma de Zacatecas, Zacatecas 98160, Mexico; (C.G.-F.); (S.G.D.); (S.C.-M.); (J.Y.C.-L.); (J.M.-R.); (M.E.C.-L.)
- Hospital General “Luz González Cosío”, Circuito Ciudad Gobierno, Zacatecas 98160, Mexico; (D.C.-G.); (E.F.G.-V.)
| | - Maria R. Rocha-Pizaña
- Escuela de Ingenieria y Ciencias, Tecnologico de Monterrey Campus Puebla, Puebla 72453, Mexico;
| | - Jacqueline Martínez-Rendón
- Molecular Medicine Laboratory, Unidad Académica de Medicina Humana y Ciencias de la Salud, Universidad Autónoma de Zacatecas, Zacatecas 98160, Mexico; (C.G.-F.); (S.G.D.); (S.C.-M.); (J.Y.C.-L.); (J.M.-R.); (M.E.C.-L.)
| | - Maria E. Castañeda-López
- Molecular Medicine Laboratory, Unidad Académica de Medicina Humana y Ciencias de la Salud, Universidad Autónoma de Zacatecas, Zacatecas 98160, Mexico; (C.G.-F.); (S.G.D.); (S.C.-M.); (J.Y.C.-L.); (J.M.-R.); (M.E.C.-L.)
| | - Idalia Garza-Veloz
- Molecular Medicine Laboratory, Unidad Académica de Medicina Humana y Ciencias de la Salud, Universidad Autónoma de Zacatecas, Zacatecas 98160, Mexico; (C.G.-F.); (S.G.D.); (S.C.-M.); (J.Y.C.-L.); (J.M.-R.); (M.E.C.-L.)
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Pang KW, Tham SL, Ng LS. Exploring the Clinical Utility of Gustatory Dysfunction (GD) as a Triage Symptom Prior to Reverse Transcription Polymerase Chain Reaction (RT-PCR) in the Diagnosis of COVID-19: A Meta-Analysis and Systematic Review. Life (Basel) 2021; 11:1315. [PMID: 34947846 PMCID: PMC8706269 DOI: 10.3390/life11121315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The diagnosis of COVID-19 is made using reverse transcription polymerase chain reaction (RT-PCR) but its sensitivity varies from 20 to 100%. The presence of gustatory dysfunction (GD) in a patient with upper respiratory tract symptoms might increase the clinical suspicion of COVID-19. AIMS To perform a systematic review and meta-analysis to determine the pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-) and diagnostic odds ratio (DOR) of using GD as a triage symptom prior to RT-PCR. METHODS PubMed and Embase were searched up to 20 June 2021. Studies published in English were included if they compared the frequency of GD in COVID-19 adult patients (proven by RT-PCR) to COVID-19 negative controls in case control or cross-sectional studies. The Newcastle-Ottawa scale was used to assess the methodological quality of the included studies. RESULTS 21,272 COVID-19 patients and 52,298 COVID-19 negative patients were included across 44 studies from 21 countries. All studies were of moderate to high risk of bias. Patients with GD were more likely to test positive for COVID-19: DOR 6.39 (4.86-8.40), LR+ 3.84 (3.04-4.84), LR- 0.67 (0.64-0.70), pooled sensitivity 0.37 (0.29-0.47) and pooled specificity 0.92 (0.89-0.94). While history/questionnaire-based assessments were predictive of RT-PCR positivity (DOR 6.62 (4.95-8.85)), gustatory testing was not (DOR 3.53 (0.98-12.7)). There was significant heterogeneity among the 44 studies (I2 = 92%, p < 0.01). CONCLUSIONS GD is useful as a symptom to determine if a patient should undergo further testing, especially in resource-poor regions where COVID-19 testing is scarce. Patients with GD may be advised to quarantine while repeated testing is performed if the initial RT-PCR is negative. FUNDING None.
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Affiliation(s)
- Khang Wen Pang
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore 119228, Singapore; (S.-L.T.); (L.S.N.)
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