Research Article
Negatif RT-PCR Testine Rağmen Bilgisayarlı Tomografi ve Klinik Özellikler ile COVID-19 Tanısı Alan Yoğun Bakım Hastalarının Retrospektif Analizi
Abstract
Özet
Amaç: COVID-19 tanısında bilgisayarlı tomografi (BT) bulgularının RT-PCR (real-time reverse transcriptase polymerase chain-reactio) testinden daha spesifik olduğu gösterilmiştir. Bu çalışmadaki amacımız SARS-CoV-2 virüsünü RT-PCR ile gösteremediğimiz ancak klinik ve BT bulguları ile COVID-19 tanısı konulan yoğun bakım hastalarının demografik, klinik özelliklerini ve mortalite oranını araştırmaktır
Gereç ve Yöntemler: 14 Mart 2020 ile 1 Haziran 2020 tarihleri arasında üçüncü basamak yoğun bakım ünitelerinde tedavi edilen, RT-PCR negatif olduğu halde klinik ve BT bulguları ile COVID-19 tanısı alan 97 hastanın, demografik, klinik özellikleri ve mortalitelerine ilişkin verileri değerlendirdik
Bulgular: Hastalarımızın ortalama yaşı 67±15 ve hastaların %67’sini erkekler oluşturmakta idi. Hastalarımızın %82’sinde en az bir komorbidite eşlik etmekteydi ve en fazla görülen komorbidite ise hipertansiyon ve diabetes mellitus (DM) idi. Hastalardaki en yaygın BT bulguları iki taraflı buzlu cam (%61),
konsolidasyon (%23), tek taraflı buzlu cam (%11) görünümü idi. Yoğun bakımda tedavi edilen RT-PCR negatif kritik COVID-19 hastalarımızın mekanik ventilasyon ihtiyacı %54, vasopressör kullanımı %43, mortalite oranı %40 idi .
Sonuç: Yoğun bakımda tedavi edilen RT-PCR pozitif COVID-19 hastalar gibi RT-PCR negatif olan ve BT, klinik ile COVID-19 hastalığı tanısı alan hastalar şiddetli hastalık ve kötü sonuçlar açısından yüksek risk altındadırlar. BT ile tanı alan hastalar da RT PCR pozitif hastalar gibi değerlendirilmeli, korunma
önlemleri alınmalı ve tedavi planı yapılmalıdır.
Gereç ve Yöntemler: 14 Mart 2020 ile 1 Haziran 2020 tarihleri arasında üçüncü basamak yoğun bakım ünitelerinde tedavi edilen, RT-PCR negatif olduğu halde klinik ve BT bulguları ile COVID-19 tanısı alan 97 hastanın, demografik, klinik özellikleri ve mortalitelerine ilişkin verileri değerlendirdik
Bulgular: Hastalarımızın ortalama yaşı 67±15 ve hastaların %67’sini erkekler oluşturmakta idi. Hastalarımızın %82’sinde en az bir komorbidite eşlik etmekteydi ve en fazla görülen komorbidite ise hipertansiyon ve diabetes mellitus (DM) idi. Hastalardaki en yaygın BT bulguları iki taraflı buzlu cam (%61),
konsolidasyon (%23), tek taraflı buzlu cam (%11) görünümü idi. Yoğun bakımda tedavi edilen RT-PCR negatif kritik COVID-19 hastalarımızın mekanik ventilasyon ihtiyacı %54, vasopressör kullanımı %43, mortalite oranı %40 idi .
Sonuç: Yoğun bakımda tedavi edilen RT-PCR pozitif COVID-19 hastalar gibi RT-PCR negatif olan ve BT, klinik ile COVID-19 hastalığı tanısı alan hastalar şiddetli hastalık ve kötü sonuçlar açısından yüksek risk altındadırlar. BT ile tanı alan hastalar da RT PCR pozitif hastalar gibi değerlendirilmeli, korunma
önlemleri alınmalı ve tedavi planı yapılmalıdır.
Keywords
Covid 19 Bilgisayarlı tomografi Yoğun bakım real-time reverse-transcriptase–polymerase-chain-reaction
Supporting Institution
yok
Project Number
yok
References
- Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S et al. Risk factors associated with acute respiratory distress syndrome and death in patients with Coronavirus Disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-943.
- COVID-19 Situation Report Turkey https://sbsgm.saglik.gov.tr/TR,66424/covid-19-situation-report-turkey.html
- Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX et al. Clinical characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;30;382(18):1708-1720.
- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497-506. Erratum in: Lancet. 2020 Jan 305.
- Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020;323(14):1406-1407.
- Zhao J, Yuan Q, Wang H, Liu W, Liao X, Su Y et al. Antibody responses to SARS-CoV-2 in patients with Novel Coronavirus Disease 2019. Clin Infect Dis. 2020;71(16):2027-2034.
- Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19) imaging reporting and data system (COVID-RADS) and common lexicon: A proposal based on the imaging data of 37 studies. Eur Radiol. 2020;30(9):4930-4942.
- Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):179-184.
- Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R et al. The Berlin definition of ARDS: An expanded rationale, justification, and supplementary material. Intensive Care Med. 2012;38(10):1573-1582.
- Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK et al. COVID-19 in Critically Ill Patients in the Seattle Region-Case Series. N Engl J Med. 2020;21;382(21):2012-2022.
- Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical characteristics of 138 hospitalized patients with 2019 Novel Coronavirus-Infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-1069.
- Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A et al. Baseline characteristics and outcomes of 1591 patients ınfected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA. 2020;323(16):1574-1581.
- Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for typical Coronavirus Disease 2019 (COVID-19) pneumonia: Relationship to negative RT-PCR testing. Radiology. 2020;296(2):41-45.
- Kong W, Agarwal PP. Chest ımaging appearance of COVID-19 infection. Radiol Cardiothorac Imaging. 2020;2(1):e200028.
- Rubin GD, Ryerson CJ, Haramati LB, Sverzellati N, Kanne JP, Raoof S et al. The Role of Chest Imaging in Patient Management During the COVID-19 Pandemic: A multinational consensus statement from the Fleischner Society. Chest. 2020;158(1):106-116.
- Pan Y, Guan H. Imaging changes in patients with 2019-nCov. Eur Radiol. 2020;30(7):3612-3613.
- Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX et al. Clinical characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720.
- Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical features of 69 cases with Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis. 2020;71(15):769-777.
- Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470-473.
- Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study [published correction appears in Lancet. 2020 Mar 28;395(10229):1038]. Lancet. 2020;395(10229):1054-1062.
- Berlin DA, Gulick RM, Martinez FJ. Severe Covid-19. N Engl J Med. 2020;383(25):2451-2460.
- Vaughn VM, Gandhi TN, Petty LA, Patel PK, Prescott HC, Malani AN et al. Empiric antibacterial therapy and community-onset bacterial co-infection in patients hospitalized with COVID-19: A Multi-Hospital Cohort Study Clin Infect Dis. 2021;72(10):533-541.
- COVID-19 (SARS-CoV-2 Enfeksiyonu) Erişkin Hasta Tedavisi, Bilimsel Danışma Kurulu Çalışması, T.C. Sağlık Bakanlığı 11 Mart 2020.
- Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-481.
- Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: A prospective cohort study. Eur Respir J. 2020;55(5):2000524.
- Liu W, Tao ZW, Wang L, Yuan ML, Liu K, Zhou L et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J (Engl). 2020;133(9):1032-1038.
Retrospective Analysis of Intensive Care Patients Diagnosed with COVID-19 with Computed Tomography and Clinical Features Despite Negative RT-PCR Test
Abstract
Objective: It has been shown that Computed Tomography’s (CT) findings are more specific than the reverse-transcriptase–polymerase-chain-reaction (RTPCR), at the diagnosis of the COVID-19 disease. Our goal in this research is to study the demographics, the clinical characteristics and the mortality rates of the COVID-19 Patients who were negative for the RT-PCR but were diagnosed through the CT scan and clinical signs
Material and Methods: From the 14th of March till the 1st of June 2020, at the tertiary intensive care unit, we had studied the demographics, clinical characteristics and mortality rates of 97 patients who were negative on the RT-PCR test, but were diagnosed as COVID-19 positive through the CT scan and the
clinical sings
Results: The mean age of the patients was 67±15 and 67% of the patients were males. Eighty two percent of the patients had at least one comorbidity, and the most common comorbidity was Hypertension and Diabetes Mellitus (DM). The most commonly seen CT signs were bilateral ground glass opacities (61%),
consolidation (23%), one-sided ground glass opacities (11%). The need for the mechanical ventilator was (54%), for the vasopressors was (43%), and the mortality rate was (40%).
Conclusion: Like RT-PCR positive COVID-19 patients treated in ICU, patients who are RT-PCR negative and diagnosed with COVID-19 disease by CT, clinical practice are at high risk for severe disease and poor outcomes. Patients diagnosed with CT should be evaluated like RT PCR positive patients, preventive
measures should be taken and a treatment plan should be made.
Material and Methods: From the 14th of March till the 1st of June 2020, at the tertiary intensive care unit, we had studied the demographics, clinical characteristics and mortality rates of 97 patients who were negative on the RT-PCR test, but were diagnosed as COVID-19 positive through the CT scan and the
clinical sings
Results: The mean age of the patients was 67±15 and 67% of the patients were males. Eighty two percent of the patients had at least one comorbidity, and the most common comorbidity was Hypertension and Diabetes Mellitus (DM). The most commonly seen CT signs were bilateral ground glass opacities (61%),
consolidation (23%), one-sided ground glass opacities (11%). The need for the mechanical ventilator was (54%), for the vasopressors was (43%), and the mortality rate was (40%).
Conclusion: Like RT-PCR positive COVID-19 patients treated in ICU, patients who are RT-PCR negative and diagnosed with COVID-19 disease by CT, clinical practice are at high risk for severe disease and poor outcomes. Patients diagnosed with CT should be evaluated like RT PCR positive patients, preventive
measures should be taken and a treatment plan should be made.
Keywords
COVID-19 Computed Tomography Intensive Care reverse-transcriptase–polymerase-chain-reaction
Project Number
yok
References
- Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S et al. Risk factors associated with acute respiratory distress syndrome and death in patients with Coronavirus Disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-943.
- COVID-19 Situation Report Turkey https://sbsgm.saglik.gov.tr/TR,66424/covid-19-situation-report-turkey.html
- Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX et al. Clinical characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;30;382(18):1708-1720.
- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497-506. Erratum in: Lancet. 2020 Jan 305.
- Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020;323(14):1406-1407.
- Zhao J, Yuan Q, Wang H, Liu W, Liao X, Su Y et al. Antibody responses to SARS-CoV-2 in patients with Novel Coronavirus Disease 2019. Clin Infect Dis. 2020;71(16):2027-2034.
- Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19) imaging reporting and data system (COVID-RADS) and common lexicon: A proposal based on the imaging data of 37 studies. Eur Radiol. 2020;30(9):4930-4942.
- Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):179-184.
- Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R et al. The Berlin definition of ARDS: An expanded rationale, justification, and supplementary material. Intensive Care Med. 2012;38(10):1573-1582.
- Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK et al. COVID-19 in Critically Ill Patients in the Seattle Region-Case Series. N Engl J Med. 2020;21;382(21):2012-2022.
- Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical characteristics of 138 hospitalized patients with 2019 Novel Coronavirus-Infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-1069.
- Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A et al. Baseline characteristics and outcomes of 1591 patients ınfected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA. 2020;323(16):1574-1581.
- Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for typical Coronavirus Disease 2019 (COVID-19) pneumonia: Relationship to negative RT-PCR testing. Radiology. 2020;296(2):41-45.
- Kong W, Agarwal PP. Chest ımaging appearance of COVID-19 infection. Radiol Cardiothorac Imaging. 2020;2(1):e200028.
- Rubin GD, Ryerson CJ, Haramati LB, Sverzellati N, Kanne JP, Raoof S et al. The Role of Chest Imaging in Patient Management During the COVID-19 Pandemic: A multinational consensus statement from the Fleischner Society. Chest. 2020;158(1):106-116.
- Pan Y, Guan H. Imaging changes in patients with 2019-nCov. Eur Radiol. 2020;30(7):3612-3613.
- Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX et al. Clinical characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720.
- Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical features of 69 cases with Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis. 2020;71(15):769-777.
- Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470-473.
- Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study [published correction appears in Lancet. 2020 Mar 28;395(10229):1038]. Lancet. 2020;395(10229):1054-1062.
- Berlin DA, Gulick RM, Martinez FJ. Severe Covid-19. N Engl J Med. 2020;383(25):2451-2460.
- Vaughn VM, Gandhi TN, Petty LA, Patel PK, Prescott HC, Malani AN et al. Empiric antibacterial therapy and community-onset bacterial co-infection in patients hospitalized with COVID-19: A Multi-Hospital Cohort Study Clin Infect Dis. 2021;72(10):533-541.
- COVID-19 (SARS-CoV-2 Enfeksiyonu) Erişkin Hasta Tedavisi, Bilimsel Danışma Kurulu Çalışması, T.C. Sağlık Bakanlığı 11 Mart 2020.
- Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-481.
- Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: A prospective cohort study. Eur Respir J. 2020;55(5):2000524.
- Liu W, Tao ZW, Wang L, Yuan ML, Liu K, Zhou L et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J (Engl). 2020;133(9):1032-1038.
There are 26 citations in total.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Araştırma Makaleleri |
| Authors | |
| Project Number | yok |
| Early Pub Date | November 1, 2022 |
| Publication Date | November 2, 2022 |
| Submission Date | April 11, 2021 |
| Acceptance Date | September 27, 2021 |
| Published in Issue | Year 2022 Volume: 17 Issue: 3 |
