SARS-CoV-2 serology increases diagnostic accuracy in CT-suspected, PCR-negative COVID-19 patients during pandemic

SARS-CoV-2 serology increases diagnostic accuracy in CT-suspected, PCR-negative COVID-19 patients during pandemic

Jochen Schneider, Hrvoje Mijočević, Kurt Ulm, Bernhard Ulm, Simon Weidlich, Silvia Würstle, Kathrin Rothe, Matthias Treiber, Roman Iakoubov, Ulrich Mayr, Tobias Lahmer, Sebastian Rasch, Alexander Herner, Egon Burian, Fabian Lohöfer, Rickmer Braren, Marcus R. Makowski, Roland M. Schmid, Ulrike Protzer, Christoph Spinner, Fabian Geisler

Abstract Background In the absence of PCR detection of SARS-CoV-2 RNA, accurate diagnosis of COVID-19 is challenging. Low-dose computed tomography (CT) detects pulmonary infiltrates with high sensitivity, but findings may be non-specific. This study assesses the diagnostic value of SARS-CoV-2 serology for patients with distinct CT features but negative PCR. Methods IgM/IgG chemiluminescent immunoassay was performed for 107 patients with confirmed (group A: PCR + ; CT ±) and 46 patients with suspected (group B: repetitive PCR-; CT +) COVID-19, admitted to a German university hospital during the pandemic’s first wave. A standardized, in-house CT classification of radiological signs of a viral pneumonia was used to assess the probability of COVID-19. Results Seroconversion rates (SR) determined on day 5, 10, 15, 20 and 25 after symptom onset (SO) were 8%, 25%, 65%, 76% and 91% for group A, and 0%, 10%, 19%, 37% and 46% for group B, respectively; (p  17d after symptom onset. Conclusions Approximately one-third of patients with distinct COVID-19 CT findings are tested negative for SARS-CoV-2 RNA by PCR rendering correct diagnosis difficult. Implementation of SARS-CoV-2 serology testing alongside current CT/PCR-based diagnostic algorithms improves discrimination between COVID-19-related and non-related pulmonary infiltrates in PCR negative patients. However, sensitivity of SARS-CoV-2 serology strongly depends on the time of testing and becomes superior to PCR after the 2nd week following symptom onset.

2021

serology, covid-19, SARS-CoV-2, computed tomography, Accuracy, Efficacy

10.1186/s12931-021-01717-9

Biotemas

Universidade Federal de Santa Catarina

Diseases of the respiratory system