COVID-19 Rapid Antigen Test at hospital admission associated to the knowledge of individual risk factors allow overcoming the difficulty of managing suspected patients in hospitals

P. Filgueiras, C. Corsini, N. B. Almeida, J. Assis, M. Pedrosa, Alana K. de Oliveira, Raquel NH Amorim, Daniel AP de Miranda, L. Coutinho, Sarah V C Gomes, Natália G Custódio, Douglas H da Silva, Gabriela PV Santos, R. A. Silva, Maria Izabella Vieira de Assis Rocha Carvalho de Medeiros, Priscila Vcc Reis, A. Lourenço, Cecília MF Bicalho, Raquel Vr Vilela, Hércules P Neves, Gabriel R. Fernandes, Rafaella F Q Grenfell
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引用次数: 12

Abstract

Early diagnosis of SARS-CoV-2 is essential to limiting the spread of the virus and managing infected patients during hospitalization. The sensitivity of RT-qPCR is contested by the fact that it is time-consuming, executed by trained technicians in proper environment for material extraction. Here, we evaluated the first SARS-CoV-2 antigen test recommended by the World Health Organization at September, 2020 as an alternative for immediate diagnosis of symptomatic and suspected patients at a hospital in Brazil during the epidemic peak. All patients were submitted to RT-qPCR and rapid antigen test using nasopharyngeal swabs rigorously collected at the same time. Demographics, baseline comorbidities, symptoms and outcomes were considered. Prediction analysis revealed that previous stroke, chronic obstructive pulmonary disease, desaturation and tachypnea were the most relevant determinants of the death of COVID-19 patients. Comparison between the rapid antigen test and RT-qPCR revealed an overall PPV of 97%, extended to 100% when performed between 4 and 15 days of symptoms, with an accuracy of 90-91% from days 1 to 7 and a Substantial agreement. The rapid antigen test presented no inconclusive result. Among the discordant results and RT-qPCR inconclusives, 72% presented bilateral multifocal ground-glass opacities on imaging and other exams alterations. The median time to obtain RT-qPCR results was 83.6 hours, against 15 minutes for the rapid test, precious time for deciding on patient isolation and management. Knowledge of the risk factors and a rapid diagnosis upon patient admission is critical to reduce mortality of COVID-19 patients, hospital internal costs and in-hospital transmission.
入院时进行新冠肺炎快速抗原检测,了解个人风险因素,可以克服医院管理疑似患者的困难
严重急性呼吸系统综合征冠状病毒2型的早期诊断对于限制病毒传播和在住院期间管理感染患者至关重要。RT-qPCR的灵敏度受到质疑,因为它是耗时的,由受过培训的技术人员在适当的环境中进行材料提取。在这里,我们评估了世界卫生组织于2020年9月推荐的第一种严重急性呼吸系统综合征冠状病毒2型抗原检测,作为在疫情高峰期在巴西一家医院立即诊断有症状和疑似患者的替代方法。所有患者都接受了RT-qPCR和快速抗原检测,同时使用严格收集的鼻咽拭子。考虑了人口学、基线合并症、症状和结果。预测分析显示,既往卒中、慢性阻塞性肺病、饱和度下降和呼吸急促是新冠肺炎患者死亡的最相关决定因素。快速抗原检测和RT-qPCR之间的比较显示,总体PPV为97%,在症状出现的4至15天内进行时,PPV延长至100%,在第1至7天的准确率为90-91%,基本一致。快速抗原检测没有得出不确定的结果。在不一致的结果和RT-qPCR结果中,72%的患者在影像学和其他检查改变中出现双侧多灶磨玻璃样阴影。获得RT-qPCR结果的中位时间为83.6小时,而快速检测为15分钟,这是决定患者隔离和管理的宝贵时间。了解风险因素并在患者入院时进行快速诊断对于降低新冠肺炎患者的死亡率、医院内部成本和院内传播至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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