ABSTRACT
Introduction Growing evidence suggest that cycle threshold (CT)-value of reverse transcription polymerase chain reaction (RT-PCR) is correlated with transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and some kits set different CT-value cut-off. This report presents the discordant results of two widely used RT-PCR kits in Indonesia due to different CT-value cut-offs and highlights its potential consequence in SARS-CoV-2 containment. Methods Nasopharyngeal swab samples with SARS-CoV-2 negative with a RT-PCR kit (manufacture pre-set CT-value cut-off was 35 amplification cycles) were retested with another RT-PCR kit with a higher pre-set CT-value of 40 amplification cycles. All procedures were performed according to the manufacturer protocols. Results In total, 30 samples with SARS-CoV-2 negative for the first kit were retested. We found that 25 out of 33 samples (75.5%) were positive using the second RT-PCR kit that had a higher manufacture pre-set CT-value cut-off. In addition, among 500 RT-PCR tests using the first RT-PCR kit, 103 of them (20.6%) were categorized as inconclusive results based on the second manufacturer’ guideline. Discussion and conclusion Our data suggest the possibility of discordant results of SARS-CoV-2 detection due to different pre-set cut-offs by the companies. As consequence, this could leave a fraction of individuals who were misclassified that could act as source of virus transmission within community.
ABSTRACT
Introduction: Growing evidence suggest that cycle threshold (CT)-value of reverse transcription polymerase chain reaction (RT-PCR) is correlated with transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and some kits set different CT-value cut-off. This report presents the discordant results of two widely used RT-PCR kits in Indonesia due to different CT-value cut-offs and highlights its potential consequence in SARS-CoV-2 containment. Methods: Nasopharyngeal swab samples with SARS-CoV-2 negative with a RT-PCR kit (manufacture pre-set CT-value cut-off was 35 amplification cycles) were retested with another RT-PCR kit with a higher pre-set CT-value of 40 amplification cycles. All procedures were performed according to the manufacturer protocols. Results: In total, 30 samples with SARS-CoV-2 negative for the first kit were retested. We found that 25 out of 33 samples (75.5%) were positive using the second RT-PCR kit that had a higher manufacture pre-set CT-value cut-off. In addition, among 500 RT-PCR tests using the first RT-PCR kit, 103 of them (20.6%) were categorized as inconclusive results based on the second manufacturer' guideline. Discussion and conclusion: Our data suggest the possibility of discordant results of SARS-CoV-2 detection due to different pre-set cut-offs by the companies. As consequence, this could leave a fraction of individuals who were misclassified that could act as source of virus transmission within community.
Introducción: La evidencia creciente sugiere que el valor del ciclo umbral (CT) de la RT-PCR (reacción en cadena de la polimerasa por transcripción inversa) guarda relación con la transmisión del síndrome respiratorio agudo severo por coronavirus 2 (SARS-CoV-2), y algunos kits establecen diferentes puntos de corte para dicho valor. El presente informe presenta la discordancia de los resultados de dos kits RT-PCR de amplio uso en Indonesia debido a los diferentes puntos de corte del valor CT, y subraya su consecuencia potencial para la contención del SARS-CoV-2. Métodos: Se reanalizaron las muestras de los hisopos nasofaríngeos negativos para SARS-CoV-2 con un kit RT-PCR (el punto de corte del valor CT preestablecido de fábrica fue de 35 ciclos de ampliación) con otro kit para RT-PCR con un valor CT establecido superior, de 40 ciclos de ampliación. Todos los procedimientos fueron realizados con arreglo a los protocolos de fabricación. Resultados: En total se reanalizaron 30 muestras con SARS-CoV-2 negativas para el primer kit. Encontramos que 25 de entre 33 muestras (75,5%) eran positivas utilizando el segundo kit para RT-PCR, que tenía un punto de corte del valor CT preestablecido superior. Además, entre las 500 pruebas RT-PCR que utilizaron el primer kit para RT-PCR, 103 de ellas (el 20,6%) fueron categorizadas como resultados no concluyentes sobre la base de la guía del segundo fabricante. Discusión y conclusión: Nuestros datos sugieren la posibilidad de discordancia en los resultados de detección del SARS-CoV-2 debido a los diferentes puntos de corte preestablecidos por los fabricantes. Por tanto, esto podría suponer que la mala clasificación de una parte de los individuos fuera la causa de la transmisión del virus dentro de la comunidad.
ABSTRACT
Background: The unpredictability of the progression of coronavirus disease 2019 (COVID-19) may be attributed to the low precision of the tools used to predict the prognosis of this disease. Objective: To identify the predictors associated with poor clinical outcomes in patients with COVID-19. Methods: Relevant articles from PubMed, Embase, Cochrane, and Web of Science were searched and extracted as of April 5, 2020. Data of interest were collected and evaluated for their compatibility for the meta-analysis. Cumulative calculations to determine the correlation and effect estimates were performed using the Z test. Results: In total, 19 papers recording 1,934 mild and 1,644 severe cases of COVID-19 were included. Based on the initial evaluation, 62 potential risk factors were identified for the meta-analysis. Several comorbidities, including chronic respiratory disease, cardiovascular disease, diabetes mellitus, and hypertension were observed more frequent among patients with severe COVID-19 than with the mild ones. Compared to the mild form, severe COVID-19 was associated with symptoms such as dyspnea, anorexia, fatigue, increased respiratory rate, and high systolic blood pressure. Lower levels of lymphocytes and hemoglobin;elevated levels of leukocytes, aspartate aminotransferase, alanine aminotransferase, blood creatinine, blood urea nitrogen, high-sensitivity troponin, creatine kinase, high-sensitivity C-reactive protein, interleukin 6, D-dimer, ferritin, lactate dehydrogenase, and procalcitonin;and a high erythrocyte sedimentation rate were also associated with severe COVID-19. Conclusion: More than 30 risk factors are associated with a higher risk of severe COVID-19. These may serve as useful baseline parameters in the development of prediction tools for COVID-19 prognosis.
ABSTRACT
Objective: To assess healthcare workers' knowledge of novel coronavirus disease 2019 (COVID-19) in the early phase of the outbreak in Indonesia.