The importance of prevalence and pre-test probability on the microbiological diagnosis of SARS-CoV-2: the case of Spain in 2020.

IF 1.9 4区 医学 Q4 MICROBIOLOGY
Revista Espanola De Quimioterapia Pub Date : 2023-10-01 Epub Date: 2023-07-21 DOI:10.37201/req/033.2023
A Canut-Blasco, C Gómez-González, R Barbero-Herranz, I Barbero-Martínez, E Abasolo-Osinaga
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引用次数: 0

Abstract

Objective: The aim of this work was to estimate the conditioned probability for the diagnosis of SARS-CoV-2 infection with reverse transcription polymerase chain reaction (RT-PCR), viral antigen rapid diagnostic tests (Ag-RDT), and antibody detection tests depending on the prevalence in the specific healthcare settings in Spain in 2020, and on the pre-test probability (PTP) according to the clinical situation, age and unknown or close contacts of the patient.

Methods: Performance parameters of tests were obtained from literature. Prevalence data and PTP were obtained from Spanish sources and a survey, respectively. The post-test probability is the positive predictive value (PPV) when test is positive. For negative result, we also calculated the probability of having the infection (false negatives).

Results: For both RT-PCR and viral Ag-RDT, the lowest PPV values were for the population screenings. This strategy proved to be useful in ruling out infection but generates a high number of false positives. At individual level, both tools provided high PPV (≥ 97%) when the PTP values are over 35%. In seroprevalence studies, though the specificity of IgG alone tests is high, under low seroprevalence, false positives cannot be avoided. Total antibodies tests are useful for diagnosis of COVID-19 in those doubtful cases with RT-PCR or Ag-RDT tests being repeatedly negative.

Conclusions: The interpretating of results depends not only on the accuracy of the test, but also on the prevalence of the infection in different settings, and the PTP associated to the patient before performing the test.

流行率和检测前概率对严重急性呼吸系统综合征冠状病毒2型微生物学诊断的重要性:2020年西班牙病例。
目的:这项工作的目的是根据2020年西班牙特定医疗机构的流行情况,估计通过逆转录聚合酶链式反应(RT-PCR)、病毒抗原快速诊断测试(Ag-RDT)和抗体检测测试诊断严重急性呼吸系统综合征冠状病毒2型感染的条件概率,以及根据患者的临床情况、年龄和未知或密切接触者的测试前概率(PTP)。方法:从文献中获得试验的性能参数。患病率数据和PTP分别来自西班牙来源和一项调查。测试后概率是测试为阳性时的阳性预测值(PPV)。对于阴性结果,我们还计算了感染(假阴性)的概率。结果:对于RT-PCR和病毒Ag-RDT,人群筛查的PPV值最低。事实证明,这种策略在排除感染方面很有用,但会产生大量假阳性。在个体水平上,当PTP值超过35%时,两种工具都提供了高PPV(≥97%)。在血清流行率研究中,尽管IgG单独检测的特异性很高,但在低血清流行率下,假阳性是不可避免的。在RT-PCR或Ag-RDT检测重复阴性的可疑病例中,总抗体检测可用于诊断新冠肺炎。结论:结果的解释不仅取决于测试的准确性,还取决于不同环境中感染的流行率,以及在进行测试前与患者相关的PTP。
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来源期刊
CiteScore
2.90
自引率
10.50%
发文量
146
审稿时长
>12 weeks
期刊介绍: The official journal of the Sociedad Española de Quimioterapia (Spanish Society of Chemotherapy), publishes articles that further knowledge and advance the science and application of antimicrobial chemotherapy with antibiotics and antifungal, antiviral and antiprotozoal agents primarily in human medicine. Authors sign an exclusive license agreement, where authors have copyright but license exclusive rights in their article to the Publisher. All manuscripts are free open access. Revista Española de Quimioterapia includes the following sections: reviews, original articles, brierf reports, letters, and consensus documents.
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