Radiological Findings Increased the Successful of COVID-19 Diagnosis in Hospitalized Patients Suspected of Respiratory Viral Infection but with a Negative First SARS-CoV-2 RT-PCR Result

Abstract

SARS-CoV-2 is the etiological agent of COVID-19 and may evolve from asymptomatic disease to fatal outcomes. Real-time reverse-transcription polymerase chain reaction (RT-PCR) screening is the gold standard to diagnose severe accurate respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but this test is not 100% accurate, as false negatives can occur. We aimed to evaluate the potential false-negative results in hospitalized patients suspected of viral respiratory disease but with a negative previous SARS-CoV-2 RT-PCR and analyze variables that may increase the success of COVID-19 diagnosis in this group of patients. A total of 55 hospitalized patients suspected of viral respiratory disease but with a previous negative RT-PCR result for SARS-CoV-2 were included. All the participants had clinical findings related to COVID-19 and underwent a second SARS-CoV-2 RT-PCR. Chest-computed axial tomography (CT) was used as an auxiliary tool for COVID-19 diagnosis. After the second test, 36 patients (65.5%) were positive for SARS-CoV-2 (COVID-19 group), and 19 patients (34.5%) were negative (controls). There were differences between the groups in the platelet count and the levels of D-dimer, procalcitonin, and glucose (p < 0.05). Chest CT scans categorized as COVID-19 Reporting and Data System 5 (CO-RADS 5) were more frequent in the COVID-19 group than in the control group (91.7% vs. 52.6%; p = 0.003). CO-RADS 5 remained an independent predictor of COVID-19 diagnosis in a second SARS-CoV-2 screening (p = 0.013; odds ratio = 7.0, 95% confidence interval 1.5−32.7). In conclusion, chest CT classified as CO-RADS 5 was an independent predictor of a positive second SARS-CoV-2 RT-PCR, increasing the odds of COVID-19 diagnosis by seven times. Based on our results, in hospitalized patients with a chest CT classified as CO-RADS 5, a second SARS-CoV-2 RT-PCR test should be mandatory when the first one is negative. This approach could increase SARS-CoV-2 detection up to 65% and could allow for isolation and treatment, thus improving the patient outcome and avoiding further contagion.

Keywords: CO-RADS; COVID-19; RT-PCR; SARS-CoV-2; false negative; viral screening.

Figure 1

Representative chest-computed axial tomography (CT) slices. Each patient was screened based on anatomical abnormalities observed on chest CT scans. (A) Chest CT findings categorized as CO-RADS 5 and (B) chest CT findings classified as CO-RADS 3. CO-RADS, COVID-19 Reporting and Data System.

Figure 2

Chest-computed axial tomography (CT) findings according to the COVID-19 Reporting and Data System (CO-RADS) classification. The study population with a negative first SARS-CoV-2 RT-PCR result (n = 55) underwent a second SARS-CoV-2 RT-PCR. According to this result, they were classified into the COVID-19 group (positive RT-PCR result) or the control group (negative RT-PCR result). At the time of admission, a chest CT was carried out, and the scans were categorized by using the CO-RADS system. The graph shows the number of patients in each group based on their CO-RADS score. Most of the patients in the COVID-19 group were classified as CO-RADS 5.