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Deprecated: Implicit conversion from float 267.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 J+Infect 2021 ; 82 (6): 260-268 Nephropedia Template TP
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Sensitivity of SARS-CoV-2 RNA polymerase chain reaction using a clinical and radiological reference standard #MMPMID33892014
Stockdale AJ; Fyles F; Farrell C; Lewis J; Barr D; Haigh K; Abouyannis M; Hankinson B; Penha D; Fernando R; Wiles R; Sharma S; Santamaria N; Chindambaram V; Probert C; Ahmed MS; Cruise J; Fordham I; Hicks R; Maxwell A; Moody N; Paterson T; Stott K; Wu MS; Beadsworth M; Todd S; Joekes E
J Infect 2021[Jun]; 82 (6): 260-268 PMID33892014show ga
OBJECTIVES: Diagnostic tests for SARS-CoV-2 are important for epidemiology, clinical management, and infection control. Limitations of oro-nasopharyngeal real-time PCR sensitivity have been described based on comparisons of single tests with repeated sampling. We assessed SARS-CoV-2 PCR clinical sensitivity using a clinical and radiological reference standard. METHODS: Between March-May 2020, 2060 patients underwent thoracic imaging and SARS-CoV-2 PCR testing. Imaging was independently double- or triple-reported (if discordance) by blinded radiologists according to radiological criteria for COVID-19. We excluded asymptomatic patients and those with alternative diagnoses that could explain imaging findings. Associations with PCR-positivity were assessed with binomial logistic regression. RESULTS: 901 patients had possible/probable imaging features and clinical symptoms of COVID-19 and 429 patients met the clinical and radiological reference case definition. SARS-CoV-2 PCR sensitivity was 68% (95% confidence interval 64-73), was highest 7-8 days after symptom onset (78% (68-88)) and was lower among current smokers (adjusted odds ratio 0.23 (0.12-0.42) p < 0.001). CONCLUSIONS: In patients with clinical and imaging features of COVID-19, PCR test sensitivity was 68%, and was lower among smokers; a finding that could explain observations of lower disease incidence and that warrants further validation. PCR tests should be interpreted considering imaging, symptom duration and smoking status.