[Comparison of the clinical characteristics between RNA positive and negative patients clinically diagnosed with coronavirus disease 2019]

Zhonghua Jie He He Hu Xi Za Zhi. 2020 May 12;43(5):427-430. doi: 10.3760/cma.j.cn112147-20200214-00095.
[Article in Chinese]

Abstract

Objective: To raise awareness about 2019 novel coronavirus pneumonia (NCP) and reduce missed diagnosis rate and misdiagnosis rate by comparing the clinical characteristics between RNA positive and negative patients clinically diagnosed with NCP. Methods: From January 2020 to February 2020, 54 patients who were newly diagnosed with NCP in Wuhan Fourth Hospital were included in this study. RT-PCR method was used to measure the level of 2019-nCov RNA in pharyngeal swab samples of these patients. The patients were divided into RNA positive and negative group, and the differences of clinical, laboratory, and radiological characteristics were compared. Results: There were 31 RNA of 2019-nCov positive cases, and 23 negative cases. Common clinical symptoms of two groups were fever (80.64% vs. 86.96%) , chills (61.29% vs. 52.17%) , cough (80.64% vs. 95.65%) , fatigue (61.30% vs. 56.52%) , chest distress (77.42% vs.73.91%) . Some other symptoms were headache, myalgia, dyspnea, diarrhea, nausea and vomiting. The laboratory and radiological characteristics of two groups mainly were lymphopenia, increased erythrocyte sedimentation rate, increased C-reactive protein, increased lactate dehydrogenase, decreased oxygenation index, normal white blood cell count and bilateral chest CT involvement. There was no statistically significant difference in other clinical characteristics except for dyspnea between two groups. Conclusions: RNA positive and negative NCP patients shared similar clinical symptoms, while RNA positive NCP patients tended to have dyspnea. Therefore, we should improve the understanding of NCP to prevent missed diagnosis and misdiagnosis; In addition, more rapid and accurate NCP diagnostic approaches should be further developed.

目的: 比较临床诊断新型冠状病毒肺炎(coronavirus disease,COVID-19)核酸检测阳性与阴性患者临床特征的差异,以提高对NCP的认识,降低漏诊及误诊率。 方法: 选取2020年1—2月武汉市第四医院临床诊断的54例NCP患者,根据实时荧光RT-PCR检测咽拭子标本的2019新型冠状病毒(2019-nCoV)核酸检测结果分为阳性组和阴性组,比较两组的临床症状、实验室及影像学检查的差异。 结果: 2019-nCoV核酸阳性组患者31例,阴性组23例;阳性组和阴性组主要临床症状均为发热(分别为80.64%和86.96%)、畏冷寒战(分别为61.29%和52.17%)、咳嗽(分别为80.64%和95.65%)、乏力(分别为61.30%和56.52%)、胸闷(分别为77.42%和73.91%),其他症状包括头痛、肌痛、呼吸困难、腹泻、恶心呕吐等。两组患者实验室检查特点主要为淋巴细胞计数减少、红细胞沉降率(ESR)增快、C反应蛋白增高、白细胞计数正常、乳酸脱氢酶增高、氧合指数降低。两组患者的胸部CT检查均以双侧受累为主。除呼吸困难症状外,两组患者其余临床特征的差异均无统计学意义。 结论: 临床诊断NCP核酸阳性与阴性患者的临床特征类似,但呼吸困难症状多出现于核酸阳性组,所以我们应提高对NCP核酸检测的认识,以防漏诊及误诊;另外需进一步寻找更快速准确确诊NCP的手段及方法。.

Keywords: 2019 novel coronavirus; Clinical characteristics; Coronavirus disease 2019.

Publication types

  • Comparative Study

MeSH terms

  • Betacoronavirus / isolation & purification
  • COVID-19
  • COVID-19 Testing
  • Clinical Laboratory Techniques / standards
  • Coronavirus Infections* / diagnosis
  • Coronavirus Infections* / pathology
  • Diagnostic Errors / statistics & numerical data
  • Humans
  • Missed Diagnosis / statistics & numerical data
  • Pandemics*
  • Pneumonia, Viral* / diagnosis
  • Pneumonia, Viral* / pathology
  • RNA, Viral* / analysis
  • SARS-CoV-2

Substances

  • RNA, Viral