Clinical, laboratory and high-resolution computed tomography (HRCT) thorax profile of reverse transcription polymerase chain reaction (RT-PCR) negative COVID-19 suspects with moderate to severe disease.

Abstract

Diagnostic dilemma arises when patients with clinical suspicion of COVID-19 disease having moderate-to-severe respiratory symptoms yield negative result for COVID-19 in reverse transcription polymerase chain reaction (RT-PCR). This study evaluated the clinical, laboratory and HRCT thorax findings among RT-PCR-negative COVID-19 suspects with moderate-to-severe disease. A hospital-based retrospective observational study was conducted between July 2021 to December 2021, among 60 moderate and severe symptomatic COVID-19 suspects admitted in the severe acute respiratory illness (SARI) ward and intensive care unit (ICU), who were negative for COVID-19 in RT-PCR. Data were abstracted from the medical records section of the hospital using a predesigned data abstraction form and presented by descriptive statistics. Mean age of study participants was 55.5 years (SD 14.1 years), and majority were males (n = 43, 71.7%). Common presenting symptoms were fever (n = 60, 100%), dyspnea (n = 57, 95%), and cough (n = 54, 90%). The common laboratory findings were rise of C-reactive protein (n = 60, 100%), NLR (n = 49, 81.7%), d-dimer (n = 47, 78.3%), ferritin (n = 46, 76.7%), and LDH (n = 40, 66.7%). HRCT scan of thorax revealed ground glass opacities with or without consolidations located bilaterally with diffuse or peripheral distribution, interlobar septal thickening (n = 43, 74.1%), vascular thickening (n = 35, ≥58.3%), and sub-pleural lines (n = 32, 53.3%). Median CT-SS value was 15 (IQR 11-19), and majority (n = 56, 93.3%) belonged to CO-RADS ≥4. Diagnosis of COVID-19 can be presumed in RT-PCR-negative suspected COVID-19 patients with moderate-to-severe disease, with marked rise of inflammatory markers and HRCT revealing typical findings of COVID-19 pneumonia.