Implementing rapid diagnostics for COVID-19

Nimmo, Camus; Agbetile, Joshua; Bhowmik, Angshu; Capocci, Santino; Rajakulasingam, Raj K

doi:10.1016/s2213-2600(20)30526-9

Cited by 4 publications

(1 citation statement)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…9,10 Notably, the unprecedented challenges from the COVID-19 pandemic have raised the level of interest in the clinical and diagnostic utility of Ct values, particularly whether rapid understanding of Ct values could be leveraged as an early measure of disease severity or utilized to guide patient management or public health decisions. [11][12][13][14] A previous systematic review on the utility of Ct values in the management of patients with SARS-CoV-2 infection showed that lower Ct values are potentially associated with worse outcomes in patients with COVID-19, and correlate with increased probability of progression to severe disease, increased disease severity, increased mortality and presence of biochemical and haematological markers. 14 Furthermore, observed changes in population distributions of SARS-CoV-2 Ct values can potentially improve estimates of an epidemic's trajectory, enabling real-time outbreak management and response.…”

Section: Introductionmentioning

confidence: 99%

Systematic review on the association between respiratory virus real-time PCR cycle threshold values and clinical presentation or outcomes

Bouzid

Vila

Hansen

et al. 2021

Journal of Antimicrobial Chemotherapy

View full text Add to dashboard Cite

Objectives It is unclear whether real-time (rt)-PCR cycle threshold (Ct) values can be utilized to guide clinical and infection-control decisions. This systematic review assesses the association between respiratory pathogen rt-PCR Ct values and clinical presentation or outcomes. Methods We searched MEDLINE, EMBASE and Cochrane library databases on 14–17 January 2020 for studies reporting the presence or absence of an association between Ct values and clinical presentation or outcomes, excluding animal studies, reviews, meta-analyses, and non-English language studies. Results Among 33 studies identified (reporting on between 9 and 4918 participants by pathogen), influenza (n = 11 studies; 4918 participants), human rhinovirus (HRV, n = 11; 2012) and respiratory syncytial virus (RSV, n = 8; 3290) were the most-studied pathogens. Low influenza Ct values were associated with mortality in 1/3 studies, with increased disease severity/duration or ICU admission in 3/9, and with increased hospitalization or length of hospital stay (LOS) in 1/6. Low HRV Ct values were associated with increased disease severity/duration or ICU admission in 3/10 studies, and with increased hospitalization or LOS in 1/3. Low RSV Ct values were associated with increased disease severity/duration or ICU admission in 3/6 studies, and with increased hospitalization or LOS in 4/4. Contradictory associations were also identified for other respiratory pathogens. Conclusions Respiratory infection Ct values may inform clinical and infection-control decisions. However, the study heterogeneity observed in this review highlights the need for standardized workflows to utilize Ct values as a proxy of genomic load and confirm their value for respiratory infection management.

show abstract

Section: Introductionmentioning

confidence: 99%

Systematic review on the association between respiratory virus real-time PCR cycle threshold values and clinical presentation or outcomes

Bouzid

Vila

Hansen

et al. 2021

Journal of Antimicrobial Chemotherapy

View full text Add to dashboard Cite

show abstract

The accuracy of novel antigen rapid diagnostics for SARS-CoV-2: a living systematic review and meta-analysis

Brümmer

Katzenschlager

Gaeddert

et al. 2021

Preprint

102

View full text Add to dashboard Cite

Background: SARS-CoV-2 antigen rapid diagnostic tests (Ag-RDTs) are increasingly being inte-grated in testing strategies around the world. Studies of the Ag-RDTs have shown variable performance. In this systematic review and meta-analysis, we assessed the clinical accuracy (sensi-tivity and specificity) of commercially available Ag-RDTs. Methods: We registered the review on PROSPERO (Registration number: CRD42020225140). We systematically searched multiple databases (PubMed, Web of Science Core Collection, medRvix and bioRvix, FINDdx) for publications up until December 11th, 2020. Descriptive analyses of all studies were performed and when more than four studies were avail-able, a random-effects meta-analysis was used to estimate pooled sensitivity and specificity in comparison to reverse transcriptase polymerase chain reaction testing. We assessed heterogeneity by subgroup analyses ((1) performed conform with manufacturers instructions for use (IFU) or not, (2) symptomatic vs. asymptomatic, (3) duration of symptoms less than seven days vs. more than seven days, (4) Ct-value <25 vs. <30 vs. >30, (5) by sample type)) and with meta-regression. We assessed study quality and risk of bias using the QUADAS 2 assessment tool. Results: From a total of 11,715 articles, we extracted 98 analytical and clinical data sets. 74 clinical accuracy data sets were evaluated that included 31,202 samples. Across all meta-analyzed samples, the pooled Ag-RDT sensitivity was 73.8% (CI 68.6 to 78.5). If analysis was re-stricted to studies that followed the Ag-RDT manufacturers instructions using fresh upper res-piratory swab samples, the sensitivity increased to 79.1% (95%CI 75.0 to 82.8). The SD Biosensor Standard Q and Abbott Panbio showed the highest sensitivity with 81.7% and 72.7%, respectively. The best Ag-RDT performance was found with nasopharyngeal sampling (77.3%, CI 72.0 to 81.9) in comparison to other sample types (e.g., anterior nasal or mid turbinate 63.5%, CI 49.5 to 75.5). Testing in the first week from symptom onset resulted in higher sensitivity (87.5%, CI 86.0 to 89.1) compared to testing after one week (64.1%, CI 54.4 to 73.8). The tests performed markedly better on samples with lower Ct-values, i.e., <30 (87.9%, CI 86.7 to 88.8), in comparison to those with Ct >30 (47.8%, CI 41.1 to 54.5). Bias concerns were raised across all data sets, and financial support from the manufacturer was reported in 28.2% of data sets. Conclusion: As Ag-RDTs detect most cases within the first week of symptom onset and those with high viral load, they can have high utility for screening purposes in the early phase of disease, and thus can be a valuable tool to fight the spread of SARS-CoV-2. Standardization of con-duct and reporting of clinical accuracy studies would improve comparability and use of data.

show abstract

Rethinking COVID-19 test sensitivity-a strategy for improving the detection limit

2021

View full text Add to dashboard Cite

Implementing rapid diagnostics for COVID-19

Cited by 4 publications

References 4 publications

Systematic review on the association between respiratory virus real-time PCR cycle threshold values and clinical presentation or outcomes

Systematic review on the association between respiratory virus real-time PCR cycle threshold values and clinical presentation or outcomes

The accuracy of novel antigen rapid diagnostics for SARS-CoV-2: a living systematic review and meta-analysis

Rethinking COVID-19 test sensitivity-a strategy for improving the detection limit

Contact Info

Product

Resources

About