Waddankeri Swaraj, Arora Kshitij, Mallasure Nitin, Konin Bharat, Mangshetty Basavaraj G
Internal Medicine, Mahadevappa Rampure Medical College, Kalaburagi, IND.
Cureus. 2022 Nov 14;14(11):e31493. doi: 10.7759/cureus.31493. eCollection 2022 Nov.
Introduction Studies have reported similar clinical, biochemical, and radiological features between real-time polymerase chain reaction (RT-PCR)-positive and RT-PCR-negative patients. Therefore, the present study aims to assess differences in RT-PCR-positive versus RT-PCR-negative patients' characteristics. Methods We prospectively included 70 consecutive patients with typical coronavirus disease 2019 (COVID-19)-like clinical features who were either RT-PCR-positive or negative, requiring admission to the intensive care unit. The patients were classified into positive and negative RT-PCR groups and evaluated for clinical features, comorbidities, laboratory findings, and radiologic features. Results Fifty-seven point one percent (57.1%; 40/70) were RT-PCR positive, and 42.9% (30/70) were RT-PCR negative patients. The respiratory rate was higher among negative patients (P = 0.02), whereas the mean duration of fever was longer (3.34 vs 2.5; P = 0.022) among positive patients. At presentation, RT-PCR-negative patients had lower saturation of peripheral oxygen (SpO2) (near significant P = 0.058). Evaluation of co-morbidities revealed no differences. The neutrophil/lymphocyte ratio (NLR) (4.57 vs 6.52; P = 0.048), C-reactive protein (CRP) (9.97 vs 22.7; P = 0.007), and serum ferritin (158 vs 248.52; P = 0.010) were higher in patients who tested negative for RT-PCR. Thrombocytopenia (2.42 vs 1.76; P = 0.009), D-dimer levels (408.91 vs 123.06; P = 0.03), and interleukin (IL-6) levels (219.3 vs 80.81; P = 0.04) were significantly elevated among RT-PCR positive patients. The percentage of lung involvement in negative cases was 42.29+/-22.78 vs 36.21+/-21.8 in positive cases (P=0.23). The CT severity score was similar in both cohorts. Conclusion Both RT-PCR-positive and negative patients have similar clinical, biochemical, and radiological features. Considering that we are amidst a pandemic, it is advisable to have a similar approach irrespective of the RT-PCR report and triage and isolate accordingly. We recommend an RT-PCR-negative intensive care unit (ICU) ward and that the treating physician take a call on the management with a holistic approach driven clinically by the laboratory findings and helped by radiological findings. Stressing only on the RT-PCR report for management can be counterproductive.
引言 研究报告了实时聚合酶链反应（RT-PCR）阳性和RT-PCR阴性患者之间相似的临床、生化和放射学特征。因此，本研究旨在评估RT-PCR阳性与RT-PCR阴性患者特征的差异。方法 我们前瞻性纳入了70例连续的具有典型2019冠状病毒病（COVID-19）样临床特征的患者，这些患者RT-PCR检测结果为阳性或阴性，均需入住重症监护病房。将患者分为RT-PCR阳性组和阴性组，并对其临床特征、合并症、实验室检查结果和放射学特征进行评估。结果 RT-PCR阳性患者占57.1%（40/70），RT-PCR阴性患者占42.9%（30/70）。阴性患者的呼吸频率较高（P = 0.02），而阳性患者的平均发热持续时间较长（3.34天对2.5天；P = 0.022）。就诊时，RT-PCR阴性患者的外周血氧饱和度（SpO2）较低（接近显著性P = 0.058）。合并症评估显示无差异。RT-PCR检测阴性的患者中性粒细胞/淋巴细胞比值（NLR）（4.57对6.52；P = 0.048）、C反应蛋白（CRP）（9.97对22.7；P = 0.007）和血清铁蛋白（158对248.52；P = 0.010）较高。RT-PCR阳性患者血小板减少症（2.42对1.76；P = 0.009）、D-二聚体水平（408.91对123.06；P = 0.03）和白细胞介素（IL-6）水平（219.3对80.81；P = 0.04）显著升高。阴性病例的肺部受累百分比为42.29±22.78，阳性病例为36.21±21.8（P = 0.23）。两个队列的CT严重程度评分相似。结论 RT-PCR阳性和阴性患者具有相似的临床、生化和放射学特征。鉴于我们正处于大流行之中，无论RT-PCR报告结果如何，建议采用相似的方法进行分诊和隔离。我们建议设立一个RT-PCR阴性重症监护病房（ICU），治疗医生应根据实验室检查结果并结合放射学检查结果，以整体方法做出管理决策。仅强调RT-PCR报告结果进行管理可能适得其反。
