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Application and Optimization of RT-PCR in Diagnosis of SARS-CoV-2 Infection

22 Pages Posted: 3 Mar 2020

See all articles by Xiaoshuai Ren

Xiaoshuai Ren

Sun Yat-Sen University (SYSU) - Clinical Laboratory

Yan Liu

Sun Yat-Sen University (SYSU) - Clinical Laboratory

Hongtao Chen

Sun Yat-Sen University (SYSU) - Clinical Laboratory

Wei Liu

Sun Yat-Sen University (SYSU) - Clinical Laboratory

Zhaowang Guo

Sun Yat-Sen University (SYSU) - Clinical Laboratory

yaqin zhang

Sun Yat-Sen University (SYSU) - Department of Radiology

Chaoqun Chen

Sun Yat-Sen University (SYSU) - Clinical Laboratory

Jianhui Zhou

Sun Yat-Sen University (SYSU) - Clinical Laboratory

Qiang Xiao

Sun Yat-Sen University (SYSU) - Clinical Laboratory

Guan-Min Jiang

Sun Yat-Sen University (SYSU) - Clinical Laboratory

Hong Shan

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Research Center of Molecular Imaging

More...

Abstract

Background: Coronavirus Disease 2019 (COVID-19) caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global threat to public health. Aiming to construct an efficient screening pattern, we comprehensively evaluated the performances of RT-PCR and chest CT in diagnosing COVID-19.

Methods: The records including demographics, RT-PCR, and CT from 87 confirmed COVID-19 cases and 481 exclusion cases were collected. The diagnostic accuracy of the pharyngeal swab RT-PCR, CT, combination with the second pharyngeal swab RT-PCR or with CT were evaluated individually. Besides, all the stool RT-PCR results were plotted by time to explore the value of stool RT-PCR.

Findings: Combination of RT-PCR and CT has the higher sensitivity (91.9%,79/86) than RT-PCR alone (78.2%,68/87) or CT alone (66.7%, 54 of 81) or combination of two RT-PCR tests (86.2%,75/87). There was good agreement between RT-PCR and CT (kappa-value, 0.430). In 34 COVID-19 cases with inconsistent results, 94.1% (n=32) are mild infection, 62.5% of which (20/32) showed positive RT-PCR. 46.7% (35/75) COVID-19 patients had at least one positive stool during the course. Two cases had positive stool earlier than the pharyngeal swabs. Importantly, one patient had consecutive positive stool but negative pharyngeal swabs.

Interpretation: Combination of RT-PCR and CT with the highest sensitivity is an optimal pattern to screen COVID-19. RT-PCR is superior to CT in diagnosing mild infections. Stool RT-PCR should be considered as an item for improving discovery rate and hospital discharge. This study shed light for optimizing scheme of screening and monitoring of SARS-CoV-2 infection.

Funding Statement: This work was supported by the National Natural Science Foundation of China (No. 81502104), National Program on Key Basic Research Project (No. 2018YFC0910600), the Nature Science Foundation of Guangdong Province, China (Grant No: 2017A030313771 and 2020A151501001 ) and the Young Teachers Nurturing Program of Sun Yat-Sen University (Grant No:17ykpy62).

Declaration of Interests: All authors declare no competing interests.

Ethics Approval Statement: The study was approved by The Fifth Affiliated Hospital of Sun Yat-sen University Ethics Committee and written informed consent was obtained from patients involved before enrolment when data were collected retrospectively.

Keywords: Coronavirus Disease 2019 (COVID-19); Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); real-time reverse transcription PCR (RT-PCR); Chest CT

Suggested Citation

Ren, Xiaoshuai and Liu, Yan and Chen, Hongtao and Liu, Wei and Guo, Zhaowang and zhang, yaqin and Chen, Chaoqun and Zhou, Jianhui and Xiao, Qiang and Jiang, Guan-Min and Shan, Hong, Application and Optimization of RT-PCR in Diagnosis of SARS-CoV-2 Infection (2/25/2020). Available at SSRN: https://ssrn.com/abstract=3546086 or http://dx.doi.org/10.2139/ssrn.3546086

Xiaoshuai Ren

Sun Yat-Sen University (SYSU) - Clinical Laboratory

Zhuhai, 519000
China

Yan Liu

Sun Yat-Sen University (SYSU) - Clinical Laboratory

Zhuhai, 519000
China

Hongtao Chen

Sun Yat-Sen University (SYSU) - Clinical Laboratory

Zhuhai, 519000
China

Wei Liu

Sun Yat-Sen University (SYSU) - Clinical Laboratory

Zhuhai, 519000
China

Zhaowang Guo

Sun Yat-Sen University (SYSU) - Clinical Laboratory

Zhuhai, 519000
China

Yaqin Zhang

Sun Yat-Sen University (SYSU) - Department of Radiology ( email )

China

Chaoqun Chen

Sun Yat-Sen University (SYSU) - Clinical Laboratory

Zhuhai, 519000
China

Jianhui Zhou

Sun Yat-Sen University (SYSU) - Clinical Laboratory

Zhuhai, 519000
China

Qiang Xiao

Sun Yat-Sen University (SYSU) - Clinical Laboratory

Zhuhai, 519000
China

Guan-Min Jiang (Contact Author)

Sun Yat-Sen University (SYSU) - Clinical Laboratory ( email )

Zhuhai, 519000
China

Hong Shan

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Research Center of Molecular Imaging ( email )

China

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