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Comparative Pilot Study between a Tomographic Score and RT-PCR to Determine Diagnostic Pbkp_rediction in Patients with COVID 19

Abstract:

In today's COVID-19 pandemic, application of RT-PCR is the diagnostic standard; however, such factors as the delayed availability of its results and the false negatives that are stemming from technical-dependent factors, the anatomical site of sampling, the time of the evolution of the symptoms and the viral load, make it possible to fail. Therefore, finding a diagnostic alternative becomes crucial, and pulmonary computed tomography (CT), using characteristic COVID-19 patterns, can fulfill this function by building tomographic scores. A prospective and observational cohort study was conducted in March-July 2020 in 30 patients with suspicion of SARS COV-2, admitted to the emergency department (ED) at Pablo Arturo Suárez Hospital. The purpose of the study was to compare the diagnostic correlation of a tomographic score and biomarkers, such as ferritin and D-dimer, with the standard RT-PCR diagnostic test. The score has a maximum value of 11 points, made up of bilateral involvement (2 points), peripheral distribution (2 points), posterior distribution (2 points), multilobar involvement (2 points), ground-glass opacification (2 points), and consolidation (1 point). The ROC curve was used to determine positive PCR pbkp_redictors for COVID-19 by determining cut-off points and calculating the parameters corresponding to the diagnostic tests. At the multivariate level, the logistic regression approach was applied. The average age of the participants was 52 years, being higher in the positive ones (57 vs. 46, p: 0.045); there was no difference in gender, comorbidities, and prognostic scales. With the ROC curve, the cut-off points were established for positive or negative diagnoses: for the CT score it was 7 (AUC: 0.77 S: 93.33% and NPV: 88.89%), and it presented an adjusted OR of 53.51 (95% CI: 3-1036, p: 0.008), while for ferritin it was 883 ng/ml (AUC: 0.74 S: 93.33% and NPV: 90.91%) and had an adjusted OR of 80.18 (95% CI: 4-1475, p: 0.003), the AUC for D-dimer was not significant. The tomographic score, created for this pilot study, yielded promising results, giving an excellent diagnostic correlation with RT-PCR, being augmented with the ferritin biomarker, and reaching a pbkp_redictive diagnostic level.