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

• Published in: Diagnostics (Basel) 2022-03, Vol.12 (3), p.687
• Main Authors: Martinez-Fierro, Margarita L, González-Fuentes, Carolina, Cid-Guerrero, Dagoberto, González Delgado, Samantha, Carrillo-Martínez, Santiago, Gutierrez-Vela, Edgar Fernando, Calzada-Luévano, Juan Yadid, Rocha-Pizaña, Maria R, Martínez-Rendón, Jacqueline, Castañeda-López, Maria E, Garza-Veloz, Idalia
• Format: Article
• Language: English
• Subjects: CO-RADS; Coronaviruses; COVID-19; Disease transmission; false negative; Fever; Genes; Genomes; Hospitalization; Hospitals; Illnesses; Infections; Laboratories; Oxygen saturation; Pandemics; Patients; Pneumonia; Proteins; Respiratory diseases; RNA polymerase; RT-PCR; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Viral infections; viral screening
• ISSN: 2075-4418; 2075-4418
• DOI: 10.3390/diagnostics12030687

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.