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印度第二波 COVID-19 中胸部 CT 与 RT-PCR 检测的相关性:一项回顾性队列研究。

Correlation between Chest CT and RT-PCR Testing in India's Second COVID - 19 Wave: A Retrospective Cohort Study.

机构信息

Rajendra Institute Medical Science, Ranchi.

出版信息

J Assoc Physicians India. 2022 Apr;70(4):11-12.

Abstract

A novel coronavirus, later designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was found to be responsible for a cluster of pneumonia cases originating in Wuhan City, Hubei province, China and the clinical disease caused by it came to be known as COVID-19. Tests in use for diagnosing COVID-19 infection in India included molecular based tests - RT-PCR, TrueNat and CBNAATAs. As COVID-19 primarily targets the lungs, Chest Computed Tomography (CT) would play a crucial role in the diagnosis, evaluation, and management of the disease. Study was done to assess the diagnostic accuracy of chest computed tomography (CT) in clinically suspected COVID - 19 patients using RT-PCR as the reference standard and establish the correlation between CT Severity Score (CTSS) and RT-PCR results. Material: A single centre tertiary care hospital based retrospective cohort suty was performed on 112 clinically suspected COVID - 19 patients between 1st April 2021 and 31st May 2021. Chest CT and RT-PCR tests were performed for all patients at a time interval of no longer than 7 days between the two tests. Patients with prior chronic respiratory illnesses were excluded. The diagnostic performance of Chest CT was evaluated using RT-PCR as the reference standard. The CTSS was calculated for all patients with positive Chest CT findings, and it was correlated with results of the RT-PCR assay. The primary outcome measures were determination of the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of Chest CT using RT-PCR as the standard of reference. The correlation between CTSS and RT-PCR was the secondary outcome. Observation: 85/112 (76%) patients tested positive on the RT-PCR whereas 91/112 (81%) had chest CT findings typical of SARS-CoV2 infection. Chest CT had a sensitivity of 90.6% [95% CI, 82.3% - 95.8%], a specificity of 48.1% [95% CI 28.7% - 68.0%], a PPV of 84.6% [95% CI, 79.2% - 88.8%], a NPV of 61.9% [95% CI, 43.0% - 77.8%] and an accuracy of 80.4% [95% CI, 71.8% - 87.3%]. There was a significant correlation between the CTSS and RT-PCR positivity (p value = 0.003) Conclusion: Chest CT has a good sensitivity in detecting COVID-19 pneumonia and is useful for moderate to-severe COVID-19 cases in resource limited settings, where RT-PCR testing is cumbersome due to lack of personnel, time, and diagnostic kits.

摘要

一种新型冠状病毒,后来被指定为严重急性呼吸系统综合症冠状病毒 2(SARS-CoV-2),被发现是导致中国湖北省武汉市肺炎病例群的罪魁祸首,由其引起的临床疾病被称为 COVID-19。在印度用于诊断 COVID-19 感染的检测方法包括基于分子的检测——RT-PCR、TrueNat 和 CBNAATAs。由于 COVID-19 主要针对肺部,因此胸部计算机断层扫描(CT)在疾病的诊断、评估和管理中发挥着至关重要的作用。本研究旨在评估 RT-PCR 作为参考标准时,对临床疑似 COVID-19 患者进行胸部 CT 检查的诊断准确性,并建立 CT 严重程度评分(CTSS)与 RT-PCR 结果之间的相关性。材料:对 2021 年 4 月 1 日至 5 月 31 日期间在一家三级医疗机构进行的 112 例临床疑似 COVID-19 患者进行了单中心回顾性队列研究。所有患者均在两次检测之间的不超过 7 天的时间间隔内同时进行胸部 CT 和 RT-PCR 检测。排除有慢性呼吸道疾病的患者。使用 RT-PCR 作为参考标准评估胸部 CT 的诊断性能。对所有具有阳性胸部 CT 结果的患者计算 CTSS,并与 RT-PCR 检测结果进行相关性分析。主要观察指标是确定 RT-PCR 作为参考标准时,胸部 CT 的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)和诊断准确性。CTSS 与 RT-PCR 之间的相关性是次要观察指标。结果:85/112(76%)例患者 RT-PCR 检测阳性,91/112(81%)例患者胸部 CT 检查有 SARS-CoV2 感染的典型表现。胸部 CT 的敏感性为 90.6%[95%CI,82.3%至 95.8%],特异性为 48.1%[95%CI,28.7%至 68.0%],PPV 为 84.6%[95%CI,79.2%至 88.8%],NPV 为 61.9%[95%CI,43.0%至 77.8%],准确性为 80.4%[95%CI,71.8%至 87.3%]。CTSS 与 RT-PCR 阳性之间存在显著相关性(p 值=0.003)。结论:胸部 CT 对 COVID-19 肺炎具有良好的敏感性,在资源有限的情况下,对于中度至重度 COVID-19 病例非常有用,在这些情况下,由于人员、时间和诊断试剂盒的缺乏,RT-PCR 检测繁琐。

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