SARS-CoV-2 serology increases diagnostic accuracy in CT-suspected, PCR-negative COVID-19 patients during pandemic
Schneider J, Mijocevic H, Ulm K, Ulm B, Weidlich S, Wuerstle S, Rothe K, Treiber M, Iakoubov R, Mayr U, Lahmer T, Rasch S, Herner A, Burian E, Lohoefer F, Braren R, Makowski MR, Schmid RM, Protzer U, Spinner C, Geisler F (2021)
Publication Type: Journal article
Publication year: 2021
Journal
Book Volume: 22
Article Number: 119
Journal Issue: 1
DOI: 10.1186/s12931-021-01717-9
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 < 0.01). Compared to hospitalized patients with a non-complicated course (non-ICU patients), seroconversion tended to occur at lower frequency and delayed in patients on intensive care units. SR of patients with CT findings classified as high certainty for COVID-19 were 8%, 22%, 68%, 79% and 93% in group A, compared with 0%, 15%, 28%, 50% and 50% in group B (p < 0.01). SARS-CoV-2 serology established a definite diagnosis in 12/46 group B patients. In 88% (8/9) of patients with negative serology > 14 days after symptom onset (group B), clinico-radiological consensus reassessment revealed probable diagnoses other than COVID-19. Sensitivity of SARS-CoV-2 serology was superior to PCR > 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.
Involved external institutions
Technische Universität München (TUM)
Germany (DE)
Deutsches Zentrum für Infektionsforschung (DZIF)
Germany (DE)
Germany (DE)
Deutsches Zentrum für Infektionsforschung (DZIF)
Germany (DE)
How to cite
APA:
Schneider, J., Mijocevic, H., Ulm, K., Ulm, B., Weidlich, S., Wuerstle, S.,... Geisler, F. (2021). SARS-CoV-2 serology increases diagnostic accuracy in CT-suspected, PCR-negative COVID-19 patients during pandemic. Respiratory Research, 22(1). https://doi.org/10.1186/s12931-021-01717-9
MLA:
Schneider, Jochen, et al. "SARS-CoV-2 serology increases diagnostic accuracy in CT-suspected, PCR-negative COVID-19 patients during pandemic." Respiratory Research 22.1 (2021).
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