SCVSA Department, University of Parma, Parma, Italy.
Laboratory Medicine Service, San Raffaele Hospital, Milan, Italy, Phone: +39 0521 906633, Fax: +39 0521 905151.
Clin Chem Lab Med. 2020 Jun 25;58(7):1095-1099. doi: 10.1515/cclm-2020-0398.
Objectives The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to date, the epidemic has gradually spread to 209 countries worldwide with more than 1.5 million infected people and 100,000 deaths. Amplification of viral RNA by rRT-PCR serves as the gold standard for confirmation of infection, yet it needs a long turnaround time (3-4 h to generate results) and shows false-negative rates as large as 15%-20%. In addition, the need of certified laboratories, expensive equipment and trained personnel led many countries to limit the rRT-PCR tests only to individuals with pronounced respiratory syndrome symptoms. Thus, there is a need for alternative, less expensive and more accessible tests. Methods We analyzed the plasma levels of white blood cells (WBCs), platelets, C-reactive protein (CRP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (GGT), alkaline phosphatase and lactate dehydrogenase (LDH) of 207 patients who, after being admitted to the emergency room of the San Raffaele Hospital (Milan, Italy) with COVID-19 symptoms, were rRT-PCR tested. Of them, 105 tested positive, whereas 102 tested negative. Results Statistically significant differences were observed for WBC, CRP, AST, ALT and LDH. Empirical thresholds for AST and LDH allowed the identification of 70% of either COVID-19-positive or -negative patients on the basis of routine blood test results. Conclusions Combining appropriate cutoffs for certain hematological parameters could help in identifying false-positive/negative rRT-PCR tests. Blood test analysis might be used as an alternative to rRT-PCR for identifying COVID-19-positive patients in those countries which suffer from a large shortage of rRT-PCR reagents and/or specialized laboratory.
目的 截至目前，严重急性呼吸综合征冠状病毒 2 （SARS-CoV-2）的爆发已逐渐蔓延至全球 209 个国家，感染人数超过 150 万，死亡人数达 10 万。实时逆转录聚合酶链反应（rRT-PCR）扩增病毒 RNA 是确认感染的金标准，但它需要较长的周转时间（生成结果需要 3-4 小时），并且假阴性率高达 15%-20%。此外，需要认证实验室、昂贵的设备和经过培训的人员，这使得许多国家将 rRT-PCR 测试仅限于具有明显呼吸道综合征症状的个体。因此，需要替代的、更便宜的、更易于获得的测试方法。 方法 我们分析了 207 名因 COVID-19 症状而入住米兰圣拉斐尔医院（意大利米兰）急诊室的患者的血浆白细胞（WBC）、血小板、C 反应蛋白（CRP）、天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、γ-谷氨酰转肽酶（GGT）、碱性磷酸酶和乳酸脱氢酶（LDH）水平。其中，105 例 rRT-PCR 检测结果为阳性，102 例 rRT-PCR 检测结果为阴性。 结果 WBC、CRP、AST、ALT 和 LDH 存在统计学显著差异。AST 和 LDH 的经验阈值允许根据常规血液检测结果识别 70%的 COVID-19 阳性或阴性患者。 结论 结合某些血液学参数的适当截止值有助于识别 rRT-PCR 的假阳性/假阴性结果。在那些严重缺乏 rRT-PCR 试剂和/或专门实验室的国家，血液测试分析可能作为 rRT-PCR 用于识别 COVID-19 阳性患者的替代方法。
