Center for Studies and Research in Intensive Care Medicine - CEPETI, Monte Castelo Street, 366, Curitiba, Paraná, 82590-300, Brazil.
Complexo Hospitalar do Trabalhador (CHT), República Argentina Street, 4406, Curitiba, Paraná, 81050-000, Brazil.
BMC Pulm Med. 2023 Mar 9;23(1):81. doi: 10.1186/s12890-023-02369-9.
The gold-standard method for establishing a microbiological diagnosis of COVID-19 is reverse-transcriptase polymerase chain reaction (RT-PCR). This study aimed to evaluate the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a set of clinical-radiological criteria for COVID-19 screening in patients with severe acute respiratory failure (SARF) admitted to intensive care units (ICUs), using reverse-transcriptase polymerase chain reaction (RT-PCR) as the reference standard.
Diagnostic accuracy study including a historical cohort of 1009 patients consecutively admitted to ICUs across six hospitals in Curitiba (Brazil) from March to September, 2020. The sample was stratified into groups by the strength of suspicion for COVID-19 (strong versus weak) using parameters based on three clinical and radiological (chest computed tomography) criteria. The diagnosis of COVID-19 was confirmed by RT-PCR (referent).
With respect to RT-PCR, the proposed criteria had 98.5% (95% confidence interval [95% CI] 97.5-99.5%) sensitivity, 70% (95% CI 65.8-74.2%) specificity, 85.5% (95% CI 83.4-87.7%) accuracy, PPV of 79.7% (95% CI 76.6-82.7%) and NPV of 97.6% (95% CI 95.9-99.2%). Similar performance was observed when evaluated in the subgroups of patients admitted with mild/moderate respiratory disfunction, and severe respiratory disfunction.
The proposed set of clinical-radiological criteria were accurate in identifying patients with strong versus weak suspicion for COVID-19 and had high sensitivity and considerable specificity with respect to RT-PCR. These criteria may be useful for screening COVID-19 in patients presenting with SARF.
新冠病毒（COVID-19）微生物学诊断的金标准方法是逆转录酶聚合酶链反应（RT-PCR）。本研究旨在评估一套针对重症急性呼吸衰竭（SARF）患者的临床影像学 COVID-19 筛查标准的准确性、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），该标准采用 RT-PCR 作为参考标准。
这是一项诊断准确性研究，纳入了 2020 年 3 月至 9 月期间连续入住巴西库里蒂巴六家医院重症监护病房（ICU）的 1009 例患者的历史队列。该样本根据三个临床和影像学（胸部计算机断层扫描）标准的参数，按照对 COVID-19 的怀疑程度（强与弱）进行分层。COVID-19 的诊断通过 RT-PCR（参照）确认。
在 RT-PCR 方面，所提出的标准具有 98.5%（95%置信区间 [95%CI]97.5-99.5%）的敏感性、70%（95%CI 65.8-74.2%）的特异性、85.5%（95%CI 83.4-87.7%）的准确性、79.7%（95%CI 76.6-82.7%）的阳性预测值和 97.6%（95%CI 95.9-99.2%）的阴性预测值。在评估轻度/中度呼吸功能障碍和严重呼吸功能障碍的患者亚组时，也观察到了类似的性能。
所提出的临床影像学标准在识别对 COVID-19 怀疑程度较强与较弱的患者方面具有准确性，对 RT-PCR 具有较高的敏感性和相当的特异性。这些标准可能有助于筛查出现 SARF 的 COVID-19 患者。
