Principe Stefania, Grosso Amelia, Benfante Alida, Albicini Federica, Battaglia Salvatore, Gini Erica, Amata Marta, Piccionello Ilaria, Corsico Angelo Guido, Scichilone Nicola
Department of Pulmonology-Palermo (PA) (Italy), AOUP Policlinico Paolo Giaccone, University of Palermo, 90127 Palermo, Italy.
Department of Respiratory Medicine-Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
J Clin Med. 2022 May 25;11(11):2993. doi: 10.3390/jcm11112993.
COVID-19 modified the healthcare system. Nasal-pharyngeal swab (NPS), with real-time reverse transcriptase-polymerase (PCR), is the gold standard for the diagnosis; however, there are difficulties related to the procedure that may postpone it. The study aims to evaluate whether other elements than the PCR-NPS are reliable and confirm the diagnosis of COVID-19. This is a cross-sectional study on data from the Lung Unit of Pavia (confirmed) and at the Emergency Unit of Palermo (suspected). COVID-19 was confirmed by positive NPS, suspected tested negative. We compared clinical, laboratory and radiological variables and performed Logistic regression to estimate which variables increased the risk of COVID-19. The derived ROC-AUCcurve, assessed the accuracy of the model to distinguish between COVID-19 suspected and confirmed. We selected 50 confirmed and 103 suspected cases. High Reactive C-Protein (OR: 1.02; CI95%: 0.11-1.02), suggestive CT-images (OR: 11.43; CI95%: 3.01-43.3), dyspnea (OR: 10.48; CI95%: 2.08-52.7) and respiratory failure (OR: 5.84; CI95%: 1.73-19.75) increased the risk of COVID-19, whereas pleural effusion decreased the risk (OR: 0.15; CI95%: 0.04-0.63). ROC confirmed the discriminative role of these variables between suspected and confirmed COVID-19 (AUC 0.91). Clinical, laboratory and imaging features predict the diagnosis of COVID-19, independently from the NPS result.
新冠疫情改变了医疗体系。鼻咽拭子（NPS）检测结合实时逆转录聚合酶链反应（PCR）是诊断的金标准；然而，该检测程序存在一些困难，可能会导致诊断延迟。本研究旨在评估除PCR-NPS检测外的其他因素是否可靠，并确诊新冠病毒感染。这是一项横断面研究，数据来自帕维亚肺病科（确诊病例）和巴勒莫急诊科（疑似病例）。通过NPS检测呈阳性确诊新冠病毒感染，检测呈阴性则为疑似病例。我们比较了临床、实验室和影像学变量，并进行逻辑回归分析以评估哪些变量会增加新冠病毒感染风险。通过推导的ROC-AUC曲线评估模型区分疑似和确诊新冠病毒感染的准确性。我们选取了50例确诊病例和103例疑似病例。高反应性C蛋白（OR：1.02；95%CI：0.11 - 1.02）、具有提示意义的CT影像（OR：11.43；95%CI：3.01 - 43.3）、呼吸困难（OR：10.48；95%CI：2.08 - 52.7）和呼吸衰竭（OR：5.84；95%CI：1.73 - 19.75）会增加新冠病毒感染风险，而胸腔积液则会降低风险（OR：0.15；95%CI：0.04 - 0.63）。ROC曲线证实了这些变量在疑似和确诊新冠病毒感染之间的鉴别作用（AUC为0.91）。临床、实验室和影像学特征可独立于NPS检测结果预测新冠病毒感染的诊断。
