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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 22-25

Do the symptoms affect SARS-CoV-2 RT-PCR results?


Department of Chest Diseases, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, Ankara, Turkey

Date of Submission27-Sep-2021
Date of Acceptance18-Dec-2021
Date of Web Publication19-Apr-2022

Correspondence Address:
Dr. Melike Aloglu
Department of Chest Diseases, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, Pinarbasi Mahallesi, Sanatoryum Caddesi, Kecioren, Ankara 06280
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacp.jacp_37_21

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  Abstract 


Background/aim: In December 2019, a novel coronavirus was defined as a pneumonia agent in China, spread all over the world, and caused severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19) pandemic. The gold standard diagnostic procedure is SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) examination, but might show false negativity. Aim of this retrospective study was to find whether symptoms of COVID-19 and SARS-CoV-2 RT-PCR positivity correlate or not, in pneumonia consistent with COVID-19. Materials and methods: Adult (≥18 years of age) patients hospitalized due to pneumonia and who had clinical and/or radiological findings (CO-RADS assessment was made) and symptoms consistent with COVID-19 were enrolled. Results: A total of 191 patients were enrolled, where 66 were females and 125 (65.4%) were males. Mean age was 59.72 ± 16.35 (range 19–89 years). Most common symptoms were dyspnea (61.8%), fever (35.6%), and cough (42.4%). Twenty-two of 191 patients had positive SARS-CoV-2 RT-PCR (11.5%). Dyspnea and fever tended to be more frequent in RT-PCR-positive cases, but in logistic regression analysis (LRA), showed no significance (P > 0.05). Conclusion: Dyspnea and fever tended to be more frequent in RT-PCR-positive cases, but in LRA, they showed no significance. Up to our results, symptoms do not matter for SARS-CoV-2 RT-PCR positivity in patients with pneumonia consistent with COVID-19.

Keywords: COVID-19, diagnosis, pneumonia, sars-cov-2 RT-PCR, symptom


How to cite this article:
Aloglu M, Gulgosteren S, Atikcan S. Do the symptoms affect SARS-CoV-2 RT-PCR results?. J Assoc Chest Physicians 2022;10:22-5

How to cite this URL:
Aloglu M, Gulgosteren S, Atikcan S. Do the symptoms affect SARS-CoV-2 RT-PCR results?. J Assoc Chest Physicians [serial online] 2022 [cited 2022 May 28];10:22-5. Available from: https://www.jacpjournal.org/text.asp?2022/10/1/22/339689




  Introduction Top


In December 2019, a novel coronavirus (2019-nCoV or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) has been discovered as a pneumonia agent in China, and then spread all over the world and caused SARS-CoV-2 (COVID-19) pandemic. Up to the present, pandemics has reached almost 192 billion confirmed cases and caused mortality of more than 4 billion people.[1]

First COVID-19 cases were diagnosed in March 2020 in our country, till then COVID-19 is the most important public-health problem of Turkey.

Up to many published studies, most common symptoms of patients with COVID-19 are fever (59–98.6%), cough (40.8–82%), dyspnea (10.9–80.4%), and fatigue/myalgia (15–69.6%). Less common symptoms were reported as diarrhea, sore throat, headache, expectoration, anosmia, ageusia, runny nose/rhinorrhea, hemoptysis, chest pain, confusion, nausea, and vomiting.[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13]

In a study from China, 31 RNA positive and 23 RNA negative, total 54 patients with pneumonia were enrolled; RNA-positive and −negative patients had similar clinical symptoms, but RNA-positive patients tended to have dyspnea more.[14]

Liu and colleagues reported 57% SARS-CoV-2 RT-PCR positivity in patients admitted to fever clinics.[15]

Fever, anosmia/ageusia and myalgia were found strongest independent predictors of positive RT-PCR in a study which enrolled 592 healthcare workers as sample.[16]


  Aim Top


of this study was to find whether symptoms of COVID-19 and SARS-CoV-2 RT-PCR positivity correlate or not in patients with pneumonia consistent with COVID-19.


  Materials and methods Top


Ethical considerations

Ethical approval was taken from Turkish Ministry of Health and University of Health Sciences Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital Ethics Committee, with approval number 667 on April 02, 2020, and also approved by Turkish Ministry of Health on May 07, 2020. Requirement for informed consent from the patients was waived off due to the retrospective nature of the study. Confidentiality of patient data was maintained throughout the study.

Patient selection

Adult (≥18 years of age) patients hospitalized due to pneumonia and who had clinical and/or radiological findings and symptoms consistent with COVID-19 were enrolled to this study.

The CO-RADS assessment scheme was used to diagnose COVID-19 in symptomatic but RT-PCR-negative patients with pneumonia.[17] RT-PCR-negative patients who met the criteria for CO-RADS category 5 (ground-glass opacities with or without consolidation in lung regions close to visceral pleura including the fissures and multifocal bilateral localization) and had one of these parameters; fever, cough, sore throat, dyspnea, travel to COVID-19-affected territories, contact with confirmed COVID-19 patient; were diagnosed and treated as COVID-19.

Demographic data, symptoms of the patients, and RT-PCR results for SARS-CoV-2 were recorded from patient files and hospital documented system. Combined naso-oropharyngeal swap specimen was used for all SARS-CoV-2 RT-PCR examinations.

Patients were grouped in two groups as positive and negative groups due to their RT-PCR results, and these two groups were compared to find symptoms of them differed or not.

Statistical method

The Statistical Package for the Social Sciences (SPSS) [Revised as IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, NY, USA)] Version 22.0 was used for the statistical analysis. Quantitative variables’ mean, standard deviation, median, lowest and highest values, frequency, and rate of the categorical variables were calculated by descriptive statistics. The distribution of variables was controlled with Kolmogorov–Smirnov test. Spearman nonparametric correlation test was used in the analysis of symptoms’ impact on SARS-CoV-2 RT-PCR results. Finally, logistic regression analysis (LRA) was performed to find out the correlation’s independency.


  Results Top


One hundred and ninety-one adult patients who met inclusion criteria were enrolled to the study: 66 (34,6%) were females and 125 (65.4%) were males. Mean age of the patient sample was 59.72 ± 16.35 (range 19–89).

All the patients had one or more symptoms, and the most common symptom was dyspnea [Table 1].
Table 1 Symptom distribution of the patients

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Mean body temperature of the patients at admission was 36.93 ± 0.72 (range 36–40°C). Twenty-nine of 191 patients’ (15%) body temperature was ≥37.5°C.

RT-PCR positivity rate was calculated as 11.52% in our patient sample.

The RT-PCR positivity in patients with fever was 17.6% (12 of 68 cases), 7.6% in patients with dyspnea (9 of 118 cases), and 14.8% in patients with cough (12 of 81 cases). Distribution of the symptoms according to RT-PCR positivity is shown in [Table 2].
Table 2 Distribution of the symptoms according to RT-PCR positivity

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When we examined whether symptoms and SARS-CoV-2 RT-PCR positivity correlate or not, dyspnea and fever were found as significant predictor symptoms for RT-PCR positivity in univariate analysis (P = 0.032 and P = 0.049, respectively). But when LRA was made to find out if they had independent impact on RT-PCR positivity or not, neither dyspnea nor fever had statistically significant difference between RT-PCR-positive and −negative groups (P > 0.05). Mean body temperatures at admission did not, either (P > 0.05) [Table 3].
Table 3 Statistical analysis results for impact of symptoms on reverse transcription-polymerase chain reaction positivity

Click here to view



  Discussion Top


In this study, most common manifestations were dyspnea, fever, and cough, as many other published studies.[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13]

In a study from China, 31 RNA positive and 23 RNA negative, total 54 patients with pneumonia were enrolled; RNA-positive and −negative patients had similar clinical symptoms, but RNA-positive patients tended to have dyspnea more.[14] Fever, anosmia/ageusia, and myalgia were found strongest independent predictors of positive RT-PCR in a study which enrolled 592 healthcare workers as sample.[16] Contrarily, we found dyspnea and fever more in RT-PCR-positive group but in LRA, both showed no significant effect.Liu and colleagues reported 57% SARS-CoV-2 RT-PCR positivity in patients admitted to fever clinics.[15] Our result for RT-PCR positivity in patients with fever was 17.6% (12 of 68 cases).

The RT-PCR positivity rate was calculated as 11.52% in our patient sample. This is a quite low ratio, but only the patients with pneumonia were enrolled to this study, and swab samples might show limited sensitivity for the initial diagnosis.[18],[19],[20]

These differences might be also due to the samples’ different ethnicity or variances/mutations of the virus in different genetic or environmental media.


  Conclusion Top


In this study, no significant effect of symptoms on RT-PCR positivity was found in COVID-19 disease. Up to our results, symptoms do not matter for SARS-CoV-2 RT-PCR positivity, in pneumonia patients consistent with COVID-19.

Limitation of this study was the small sample size of RT-PCR-positive cases when compared with negative ones. This result could also be validated by studies with larger sample sizes.

Authors’ contribution

Melike Aloğlu: Concept, design, definition of intellectual content, literature search, clinical studies, experimental studies, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing, and manuscript review.

Sevtap Gülgösteren: Literature search, clinical studies, experimental studies, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing, and manuscript review

Şükran Atikcan: Data acquisition, data analysis, manuscript editing, and manuscript review.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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WHO COVID-19 Dashboard. Geneva: World Health Organization; 2021. Available at https://covid19.who.int/  Back to cited text no. 1
    
2.
Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E et al. Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19). Electronic address: https://www.lancovid.org. Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis. Travel Med Infect Dis 2020;34:101623. Available on the website https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102608/  Back to cited text no. 2
    
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Yang W, Cao Q, Qin L et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): a multi-center study in Wenzhou city, Zhejiang, China. J Infect 2020;80:388-93.  Back to cited text no. 3
    
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Wang D, Hu B, Hu C et al. Clinical characteristics of 138 hospitalized patients with2019 novel coronavirus-infected pneumonia in Wuhan, China. J Am Med Assoc 2020;323:1061-9. Erratum in: J Am Med Assoc 2021;325:1113.  Back to cited text no. 4
    
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Xu XW, Wu XX, Jiang XG et al. Clinical findings in a group of patients infected with the2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. Br Med J 2020;368:m606. Erratum in: Br Med J 2020;368:m792.  Back to cited text no. 6
    
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Wu J, Wu X, Zeng W et al. Chest CT findings in patients with coronavirus disease 2019 and its relationship with clinical features. Investig Radiol 2020;55:257-61.  Back to cited text no. 7
    
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Adhikari SP, Meng S, Wu YJ et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty 2020;9:29.  Back to cited text no. 10
    
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Wong HYF, Lam HYS, Fong AH et al. Frequency and distribution of chest radiographic findings in patients positive for COVID-19. Radiology 296:E72-8.  Back to cited text no. 11
    
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Guan WJ, Ni ZY, Hu Y et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.  Back to cited text no. 12
    
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Fu Y, Li Y, Guo E et al. Dynamics and correlation among viral positivity, seroconversion, and disease severity in COVID-19: a retrospective study. Ann Intern Med 2021;174:453-61.  Back to cited text no. 13
    
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Li YY, Wang WN, Lei Y et al. Comparison of the clinical characteristics between RNA positive and negative patients clinically diagnosed with coronavirus disease2019. Chin J Tuberculosis Res Dis 2020;43:427-30.  Back to cited text no. 14
    
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Liu R, Han H, Liu F et al. Positive rate of RT-PCR detection of SARS-CoV-2 infection in 4880 cases from one hospital in Wuhan, China, from Jan to Feb 2020. Clin Chim Acta 2020;505:172-5.  Back to cited text no. 15
    
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Lan FY, Filler R, Mathew S et al. COVID-19 symptoms predictive of healthcare workers’ SARS-CoV-2 PCR results. PLoS One 2020;15:e0235460.  Back to cited text no. 16
    
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Prokop M, van Everdingen W, van Rees Vellinga T et al. CO-RADS: a categorical CT assessment scheme for patients suspected of having COVID-19-definition and evaluation. Radiology 2020;296:E97-104.  Back to cited text no. 17
    
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Wölfel R, Corman VM, Guggemos W et al. Virological assessment of hospitalized patients with COVID-2019. Nature 2020;581:465-9. Erratum in: Nature 2020;588:E35.  Back to cited text no. 18
    
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Drosten C, Chiu LL, Panning M et al. Evaluation of advanced reverse transcription-PCR assays and an alternative PCR target region for detection of severe acute respiratory syndrome-associated coronavirus. J Clin Microbiol 2004; 42:2043-7.  Back to cited text no. 19
    
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Peiris JS, Chu CM, Cheng VC et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet 2003;361:1767-72.  Back to cited text no. 20
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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