ABSTRACT
Background: Reverse transcriptase-polymerase chain reaction (RT PCR) testing is an important tool for the diagnosis of coronavirus disease 2019 (COVID19). However, performance concerns have recently emerged, especially about its sensitivity.. We hypothesized that clinical, biological and radiological characteristics of patients with false negative first RT-PCR testing, despite final diagnosis of COVID19, might differ from patients with positive first RT PCR. Methods: Case / control, multicenter study in which COVID19 patients with negative first RT PCR testing were matched to patients with positive first RT PCR on age, gender and initial admission unit (ward or intensive care). Results: Between March 30, and June 22, 2020, 80 cases and 80 controls were included. Neither proportion of death at hospital discharge, nor duration of hospital length stay differed between case and control patients (P=0.80 and P=0.54, respectively). In multivariate analysis, headache (adjusted OR: 0.07 [0.01 ; 0.49]; P=0.007) and fatigue/malaise (aOR: 0.16 [0.03 ; 0.81]; P=0.027) were associated with lower risk of false negative, whereas platelets > 207.103.mm-3 (aOR: 3.81 [1.10 ; 13.16]; P=0.034) and CRP > 79.8 mg.L-1 (aOR: 4.00 [1.21 ; 13.19]; P=0.023) were associated with higher risk of false negative. Interpretation: Patients with suspected COVID19 and higher inflammatory biological signs expected higher risk of false negative RT PCR testing. Strategy of serial RT PCR testings must be rigorously evaluated before adoption by clinicians.
ABSTRACT
BackgroundLimited data are available for antiviral therapy efficacy especially for the most severe patients under mechanical ventilation suffering from Covid-19 related Acute Respiratory Distress Syndrome (ARDS). MethodsObservational multicenter cohort of patients with moderate to severe Covid-19 ARDS, comparing antiviral strategies (none, hydroxychloroquine (HCQ), lopinavir/ritonavir (L/R), others (combination or remdesivir). The primary end-point was the day-28 ventilator free days (VFD), patients which died before d28 were considered as having 0 VFD. The variable was dichotomized in patients still ventilated or dead at day 28 vs patients being extubated and alive at day 28 (VFD = or >0). ResultsWe analyzed 376 patients (80 with standard of care (SOC), 49 treated with L/R, 197 with HCQ, and 50 others). The median number of d28-VFD was 0 (IQR 0-13) and was different across the different groups (P=0.01), the SOC patients having the highest d28-VFD. A multivariate logistic regression including antiviral strategies, showed that age (OR 0.95 CI95%:0.93-0.98), male gender (OR 0.53 CI95%:0.31-0.93), Charlson score (OR 0.85 CI95%:0.73-0.99) and plateau pressure (OR 0.94 CI95%:0.88-0.99) were associated with having 0 d28-VFD whereas P/F ratio (OR 1.005 CI95%:1.001-1.010) was associated with having [≥]1 d28-VFD (ie. being extubated and alive). Acute kidney injury (AKI) was frequent (64%), its incidence was different across the patients groups (P=0.01). In a post-hoc logistic multivariate regression apart from demographics characteristics and comorbidities, the use of L/R (administered to 81 of 376 patients was associated with occurrence of AKI (OR 2.07 CI95%:1.17-3.66) and need for renal replacement therapy (RRT). ConclusionIn this observational study of moderate to severe Covid-19 ARDS patients, we did not observed a benefit of treating patients with any specific antiviral treatment. We observed an association between L/R treatment and occurrence of AKI and need for RRT. Take home messageAny specific COVID-19 antiviral treatment is associated with higher ventilator free days at day 28 as compared to no antiviral treatment for patient in ICU under invasive mechanical ventilation. Lopinavir/ritonavir is associated with an increased risk of acute kidney injury. TweetCOVID-19: Insights from ARDS cohort: no signal of efficacy for antiviral treatments. Lopinavir/ritonavir may be associated with AKI and need for RRT.
