Diagnosis of COVID-19 in Patients with Negative Nasopharyngeal Swabs: Reliability of Radiological and Clinical Diagnosis and Accuracy Versus Serology

Mirijello, Antonio; Zarrelli, Michele; Miscio, Giuseppe; Matthaeis, Angela de; Piscitelli, Pamela; Carbonelli, Cristiano; Giorgio, Annabella Di; Inglese, Michele; Ciliberti, Gianluca; Marciano, Carmen; Borelli, Cristina; Vergara, Doriana; Castorani, Giulia; Orciulo, Grazia Vittoria; Mauro, Lazzaro Di; Carella, Massimo; Simeone, Annalisa; Copetti, Massimiliano; Leone, Maurizio; Cosmo, Salvatore De; CSS-COVID-Group, the

doi:10.3390/diagnostics11030386

Cited by 6 publications

(7 citation statements)

References 23 publications

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“…From 3 March to 31 May 2020, all consecutive patients aged ≥18 years suspected of COVID-19 infection were admitted to our COVID units (internal medicine and geriatric units). All patients had epidemiologic, clinical, laboratory and radiological findings suspected for COVID-19 [ 10 ]. Real-time reverse-transcriptase polymerase chain reaction from nasopharyngeal swab was performed in all patients and repeated, in the case of a negative result, as appropriate.…”

Section: Methodsmentioning

confidence: 99%

Factors Associated with Delirium in COVID-19 Patients and Their Outcome: A Single-Center Cohort Study

et al. 2022

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Background: A significant proportion of patients with coronavirus disease 2019 (COVID-19) suffer from delirium during hospitalization. This single-center observational study investigates the occurrence of delirium, the associated risk factors and its impact on in-hospital mortality in an Italian cohort of COVID 19 inpatients. Methods: Data were collected in the COVID units of a general medical hospital in the South of Italy. Socio-demographic, clinical and pharmacological features were collected. Diagnosis of delirium was based on a two-step approach according to 4AT criteria and DSM5 criteria. Outcomes were: dates of hospital discharge, Intensive Care Unit (ICU) admission, or death, whichever came first. Univariable and multivariable proportional hazards Cox regression models were estimated, and risks were reported as hazard ratios (HR) along with their 95% confidence intervals (95% CI). Results: A total of 47/214 patients (22%) were diagnosed with delirium (21 hypoactive, 15 hyperactive, and 11 mixed). In the multivariable model, four independent variables were independently associated with the presence of delirium: dementia, followed by age at admission, C-reactive protein (CRP), and Glasgow Coma Scale. In turn, delirium was the strongest independent predictor of death/admission to ICU (composite outcome), followed by Charlson Index (not including dementia), CRP, and neutrophil-to-lymphocyte ratio. The probability of reaching the composite outcome was higher for patients with the hypoactive subtype than for those with the hyperactive subtype. Conclusions: Delirium was the strongest predictor of poor outcome in COVID-19 patients, especially in the hypoactive subtype. Several clinical features and inflammatory markers were associated with the increased risk of its occurrence. The early recognition of these factors may help clinicians to select patients who would benefit from both non-pharmacological and pharmacological interventions in order to prevent delirium, and in turn, reduce the risk of admission to ICU or death.

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Section: Methodsmentioning

confidence: 99%

Factors Associated with Delirium in COVID-19 Patients and Their Outcome: A Single-Center Cohort Study

et al. 2022

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“…During the first pandemic wave (from March to May 2020), the COVID-19 Units of our tertiary-care hospital managed a total of 254 patients admitted for suspected SARS-CoV-2 infection. All admitted patients had epidemiological, clinical, laboratory, and radiologic findings suspected for COVID-19 [21]. Real-time reverse-transcriptase-polymerasechain-reaction (RT-PCR) from a naso-pharyngeal swab was performed in all patients, and repeated, in the case of a negative result, as appropriate, according to guidelines [22].…”

Section: Patientsmentioning

confidence: 99%

“…As already described, 169 patients had a swab-confirmed diagnosis, 26 diagnoses were antibody-confirmed, and 37 patients, despite negative swabs, showed typical clinical and radiological features of COVID-19. A total of 22 patients were considered non-COVID and excluded from the sample due to an alternative diagnosis [21]. The Ethics Committee of our Institution approved the study (COVID-19-CSS, num.…”

Section: Patientsmentioning

confidence: 99%

Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients

Mirijello

Piscitelli

Matthaeis

et al. 2021

JCM

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Background: The clinical course of COVID-19 is more severe in elderly patients with cardio-metabolic co-morbidities. Chronic kidney disease is considered an independent cardiovascular risk factor. We aimed to evaluate the impact of reduced eGFR on the composite outcome of admission to ICU and death in a sample of consecutive COVID-19 hospitalized patients. Methods: We retrospectively evaluated clinical records of a consecutive sample of hospitalized COVID-19 patients. A total of 231 patients were considered for statistical analysis. The whole sample was divided in two groups on the basis of eGFR value, e.g., ≥ or <60 mL/min/1.73 m2. Patients with low eGFR were further divided among those with a history of chronic kidney disease (CKD) and those without (AKI, acute kidney injury). The primary outcome was a composite of admission to ICU or death, whichever occurred first. The single components were secondary outcomes. Results: Seventy-nine (34.2%) patients reached the composite outcome. A total of 64 patients (27.7%) died during hospitalization, and 41 (17.7%) were admitted to the ICU. A significantly higher number of events was present among patients with low eGFR (p < 0.0001). Age (p < 0.001), SpO2 (p < 0.001), previous anti-platelet treatment (p = 0.006), Charlson’s Comorbidities Index (p < 0.001), serum creatinine (p < 0.001), eGFR (p = 0.003), low eGFR (p < 0.001), blood glucose levels (p < 0.001), and LDH (p = 0.003) were significantly associated with the main outcome in univariate analysis. Low eGFR (HR 1.64, 95% CI 1.02–2.63, p = 0.040) and age (HR per 5 years 1.22, 95% CI 1.10–1.36, p < 0.001) were significantly and independently associated with the main outcome in the multivariate model. Patients with AKI showed an increased hazard ratio to reach the combined outcome (p = 0.059), while those patients with both CKD had a significantly higher probability of developing the combined outcome (p < 0.001). Conclusions: Patients with reduced eGFR at admission should be considered at high risk for clinical deterioration and death, requiring the best supportive treatment in order to prevent the worst outcome.

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“…Given these performances, compared with chest CT scan, LUS carries from one hand the risk of underdiagnosis and/or underestimation of the extent of the disease and, from the other hand, the possibility to erroneously classify pre-existing or overlapping conditions as COVID-19 pneumonia. In the setting of COVID-19 pandemic and by trained hands, LUS may represent an expanded clinical evaluation to suggest even the presence of “a virosis,” when integrated into a multimodal approach including clinical, epidemiological, laboratory, and radiologic findings ( 53 , 54 ). In any case, viral testing confirmation is always required.…”

Section: Discussionmentioning

confidence: 99%

Lung Ultrasound in the Diagnosis of COVID-19 Pneumonia: Not Always and Not Only What Is COVID-19 “Glitters”

et al. 2021

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Background: In the current coronavirus disease-2019 (COVID-19) pandemic, lung ultrasound (LUS) has been extensively employed to evaluate lung involvement and proposed as a useful screening tool for early diagnosis in the emergency department (ED), prehospitalization triage, and treatment monitoring of COVID-19 pneumonia. However, the actual effectiveness of LUS in characterizing lung involvement in COVID-19 is still unclear. Our aim was to evaluate LUS diagnostic performance in assessing or ruling out COVID-19 pneumonia when compared with chest CT (gold standard) in a population of SARS-CoV-2-infected patients.Methods: A total of 260 consecutive RT-PCR confirmed SARS-CoV-2-infected patients were included in the study. All the patients underwent both chest CT scan and concurrent LUS at admission, within the first 6–12 h of hospital stay.Results: Chest CT scan was considered positive when showing a “typical” or “indeterminate” pattern for COVID-19, according to the RSNA classification system. Disease prevalence for COVID-19 pneumonia was 90.77%. LUS demonstrated a sensitivity of 56.78% in detecting lung alteration. The concordance rate for the assessment of abnormalities by both methods increased in the case of peripheral distribution and middle-lower lung location of lesions and in cases of more severe lung involvement. A total of nine patients had a “false-positive” LUS examination. Alternative diagnosis included chronic heart disease (six cases), bronchiectasis (two cases), and subpleural emphysema (one case). LUS specificity was 62.50%. Collateral findings indicative of overlapping conditions at chest CT were recorded also in patients with COVID-19 pneumonia and appeared distributed with increasing frequency passing from the group with mild disease (17 cases) to that with severe disease (40 cases).Conclusions: LUS does not seem to be an adequate tool for screening purposes in the ED, due to the risk of missing some lesions and/or to underestimate the actual extent of the disease. Furthermore, the not specificity of LUS implies the possibility to erroneously classify pre-existing or overlapping conditions as COVID-19 pneumonia. It seems more safe to integrate a positive LUS examination with clinical, epidemiological, laboratory, and radiologic findings to suggest a “virosis.” Viral testing confirmation is always required.

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Diagnosis of COVID-19 in Patients with Negative Nasopharyngeal Swabs: Reliability of Radiological and Clinical Diagnosis and Accuracy Versus Serology

Cited by 6 publications

References 23 publications

Factors Associated with Delirium in COVID-19 Patients and Their Outcome: A Single-Center Cohort Study

Factors Associated with Delirium in COVID-19 Patients and Their Outcome: A Single-Center Cohort Study

Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients

Lung Ultrasound in the Diagnosis of COVID-19 Pneumonia: Not Always and Not Only What Is COVID-19 “Glitters”

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