疑似 COVID-19 住院患者的临床和生化特征及转归：RT-PCR 咽拭子阳性与阴性比较。
Clinical and biochemical characteristics and outcomes of suspected COVID-19 hospitalized patients: RT-PCR swab positive and negative comparison.
机构信息
Department of Internal Medicine, College of Medicine, and King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Department of Internal Medicine, College of Medicine, and King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
出版信息
J Infect Public Health. 2021 Nov;14(11):1623-1629. doi: 10.1016/j.jiph.2021.09.014. Epub 2021 Sep 23.
BACKGROUND
COVID-19 is diagnosed using RT-PCR assays of samples from nasal and oropharyngeal swabs. People with negative RT-PCR often presented with clinical manifestations of COVID-19. The data on such patients are lacking. The present study aims to characterize the patients who were suspected COVID-19 cases and tested negative in RT-PCR compared to patients who had been tested RT-PCR positive.
METHODS
This is a retrospective, observational study of adult suspected and confirmed patients of COVID-19 admitted to King Saud University Medical City, Riyadh, Saudi Arabia, from 1st March 2020 until 30th November 2020. Laboratory confirmation is done through nasal/pharyngeal swab specimens, tested positive in RT-PCR assay. Patients with initial negative RT-PCR test results were assessed again within 48-72 h to avoid false-negative results. Patient data were extracted from the electronic medical files of each included patient using a predesigned case report form.
RESULTS
The study included 488 (80.93%) patients with RT-PCR swab results positive, and 115 (19.07%) patients who were negative. Respiratory rate and diastolic blood pressure were higher among the swab-positive cases. More number of swab-negative patients had comorbidities such as coronary heart disease, chronic kidney disease, and carcinoma. Fever, cough, and shortness of breath were reported higher among the swab-positive cases. ALT and AST, and LDH levels were found higher among RT-PCR-positive patients. Serum creatinine, blood urea nitrogen and troponin were more elevated in RT-PCR-negative patients. Antibiotics, anticoagulants, and corticosteroids were used more by swab-positive patients. Significantly higher number of RT-PCR-positive patients required proning, high-flow nasal cannula, non-invasive mechanical ventilation, and invasive mechanical ventilation. Acute cardiac ischemia and death were found to be similar among the patients. However, deaths occurred significantly earlier among the swab-positive cases when compared to the swab-negative group.
CONCLUSION
Distinctive symptoms and markers of COVID-19 are more frequent among patients who had RT-PCR-positive results.
背景
COVID-19 的诊断采用来自鼻腔和口咽拭子样本的 RT-PCR 检测。许多 RT-PCR 检测结果为阴性的患者表现出 COVID-19 的临床症状。目前缺乏这些患者的数据。本研究旨在描述 RT-PCR 检测结果为阴性的疑似 COVID-19 患者与 RT-PCR 检测结果为阳性的患者之间的差异。
方法
这是一项回顾性、观察性研究，纳入了 2020 年 3 月 1 日至 2020 年 11 月 30 日期间在沙特阿拉伯利雅得的沙特国王大学医学城收治的疑似和确诊 COVID-19 的成年患者。通过 RT-PCR 检测鼻腔/咽拭子标本进行实验室确诊。最初 RT-PCR 检测结果为阴性的患者在 48-72 小时内再次评估，以避免假阴性结果。使用预先设计的病例报告表从每位纳入患者的电子病历中提取患者数据。
结果
本研究共纳入 488 例 RT-PCR 拭子结果阳性患者（80.93%）和 115 例 RT-PCR 拭子结果阴性患者（19.07%）。呼吸频率和舒张压在拭子阳性病例中更高。更多的拭子阴性患者存在冠心病、慢性肾脏病和癌症等合并症。拭子阳性病例中报告的发热、咳嗽和呼吸急促更多。丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）和乳酸脱氢酶（LDH）水平在 RT-PCR 阳性患者中更高。血清肌酐、血尿素氮和肌钙蛋白在 RT-PCR 阴性患者中升高更明显。抗生素、抗凝剂和皮质类固醇在拭子阳性患者中更常用。RT-PCR 阳性患者需要俯卧位、高流量鼻导管、无创机械通气和有创机械通气的比例显著更高。急性心肌缺血和死亡在患者中相似。然而，与拭子阴性组相比，拭子阳性组的死亡发生更早。
结论
RT-PCR 检测结果为阳性的患者中 COVID-19 的症状和标志物更为明显。
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