Predictors of negative first SARS-CoV-2 RT-PCR despite final diagnosis of COVID-19 and association with outcome
Open Access
- 26 January 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Scientific Reports
- Vol. 11 (1), 1-7
- https://doi.org/10.1038/s41598-021-82192-6
Abstract
Reverse transcriptase-polymerase chain reaction (RT-PCR) testing is an important tool for diagnosing coronavirus disease 2019 (COVID-19). However, performance concerns have emerged recently, notably regarding sensitivity. We hypothesized that the clinical, biological, and radiological characteristics of patients with a false-negative first RT-PCR test and a final diagnosis of COVID-19 might differ from those of patients with a positive first RT-PCR test. We conducted a multicenter matched case-control study in COVID-19 patients. Patients with a negative first RT-PCR test were matched to patients with a positive first RT-PCR test on age, sex, and initial admission unit (ward or intensive care). We included 80 cases and 80 controls between March 30, and June 22, 2020. Neither mortality at hospital discharge nor hospital stay length differed between the two groups (P=0.80 and P=0.54, respectively). By multivariate analysis, two factors were independently associated with a lower risk of a first false-negative test, namely, headache (adjusted OR [aOR], 0.07; 95% confidence interval [95% CI], 0.01-0.49]; P=0.007) and fatigue/malaise (aOR, 0.16; 95% CI, 0.03-0.81; P=0.027); two other factors were independently associated with a higher risk of a first false-negative test, namely, platelets>207.10(3) mm(-3) (aOR, 3.81; 95% CI, 1.10-13.16]; P=0.034) and C-reactive protein>79.8 mg.L-1 (aOR, 4.00; 95% CI, 1.21-13.19; P=0.023). Patients with suspected COVID-19 whose laboratory tests indicating marked inflammation were at higher risk of a first false-negative RT-PCR test. Strategies involving serial RT-PCR testing must be rigorously evaluated.This publication has 26 references indexed in Scilit:
- Performance of Radiologists in Differentiating COVID-19 from Non-COVID-19 Viral Pneumonia at Chest CTRadiology, 2020
- Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 CasesRadiology, 2020
- Clinical Characteristics of Coronavirus Disease 2019 in ChinaThe New England Journal of Medicine, 2020
- COVID-19: consider cytokine storm syndromes and immunosuppressionThe Lancet, 2020
- Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort studyThe Lancet, 2020
- Evaluating the accuracy of different respiratory specimens in the laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infectionsPublished by Cold Spring Harbor Laboratory ,2020
- False-Negative Results of Real-Time Reverse-Transcriptase Polymerase Chain Reaction for Severe Acute Respiratory Syndrome Coronavirus 2: Role of Deep-Learning-Based CT Diagnosis and Insights from Two CasesKorean Journal of Radiology, 2020
- Prehospital Delay in Older Adults with Acute Myocardial Infarction: The ComprehenSIVe Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction StudyJournal of the American Geriatrics Society, 2017
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studiesThe Lancet, 2007
- A new look at the statistical model identificationIEEE Transactions on Automatic Control, 1974