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To Retest or Not to Retest the Experience of a Cardiology Emergency Clinic During the COVID-19 Pandemic

Miruna F. Ştefan
Miruna F. Ştefan
, 
Stefania L. Magda
Stefania L. Magda
, 
Dan V. Bratu
Dan V. Bratu
, 
Graţiela Cosmulescu
Graţiela Cosmulescu
, 
Maria C.B. Şuran
Maria C.B. Şuran
, 
Elena Bădulescu
Elena Bădulescu
, 
Andreea E. Velcea
Andreea E. Velcea
, 
Sorina Mihăilă
Sorina Mihăilă
, 
Loredana Iacobescu
Loredana Iacobescu
, 
Roxana C. Rimbaş
Roxana C. Rimbaş
 und 
Dragoş Vinereanu
Dragoş Vinereanu
   | 01. Sept. 2022
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Article Category: Original Article
Online veröffentlicht: 01. Sept. 2022
Seitenbereich: 93 - 102
DOI: https://doi.org/10.2478/rjc-2022-0018
Schlüsselwörter
© 2022 Miruna F. Ştefan et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Flowchart of the negative retested and the positive retested patients hospitalized in the Cardiology Unit between 1st May 2020 and 31st December 2020.
Flowchart of the negative retested and the positive retested patients hospitalized in the Cardiology Unit between 1st May 2020 and 31st December 2020.

Figure 2

Most important reasons for deciding RT-PCR retesting of patients, expressed in percent.
Most important reasons for deciding RT-PCR retesting of patients, expressed in percent.

Figure 3

Secondary most important for deciding RT-PCR retesting of patients, expressed in percent.
Secondary most important for deciding RT-PCR retesting of patients, expressed in percent.

Figure 4

Comparison between admission diagnostic in negative-retested and positive patients, expressed in percent from the entire lots.
Comparison between admission diagnostic in negative-retested and positive patients, expressed in percent from the entire lots.

Figure 5

Patients exhibiting both symptoms and imagistic changes on Chest X-ray or thoracic CT-scan, expressed in percent (comparison between negative-retested and positive patients).
Patients exhibiting both symptoms and imagistic changes on Chest X-ray or thoracic CT-scan, expressed in percent (comparison between negative-retested and positive patients).

Figure 6

ROC curves for different parameters and the result of the first and second RT-PCR test. Panel A- ROC curve for the concomitant presence of both Covid-19 suggestive symptoms and imagistic changes and the result of the first RT-PCR test (AUC=0.626, CI 0.542–0.710), Panel B- ROC curve for the concomitant presence of both Covid-19 suggestive symptoms and imagistic changes and the result of the second RT-PCR test (AUC=0.683, CI 0.548–0.817), Panel C- ROC curve for the presence of lymphopenia at admission and the result of the first RTPCR test (AUC=0.527, CI 0.438–0.616), Panel D- ROC curve for the presence of lymphopenia at admission and the result of the second RT-PCR test (AUC=0.563, CI 0.412–0.713), Panel E- ROC curve for the value of ferritin at admission and the result of the first RT-PCR test (for a value >172ug/L, a sensitivity of 71% and a specificity of 55.5%, AUC=0.648, CI 0.551–0.746), Panel F- ROC curve for the value of ferritin at admission and the result of the second RT-PCR test (for a value >162.5ug/L, a sensitivity of 77.8% and a specificity of 56.1%, AUC=0.618, CI 0.464–0.771), Panel G- ROC curve for the maximum temperature during hospitalization and the result of the first RT-PCR test (for a value >37.3 Celsius grades, a sensitivity of 75% and a specificity of 66.2%, AUC=0.680, CI 0.533–0.827), Panel H- ROC curve for the maximum temperature during hospitalization and the result of the second RT-PCR test (for a value >37.5 Celsius grades, a sensitivity of 100% and a specificity of 76.8%, AUC=0.862, CI 0.795–0.929), Se-sensitivity, Sp-specificity.
ROC curves for different parameters and the result of the first and second RT-PCR test. Panel A- ROC curve for the concomitant presence of both Covid-19 suggestive symptoms and imagistic changes and the result of the first RT-PCR test (AUC=0.626, CI 0.542–0.710), Panel B- ROC curve for the concomitant presence of both Covid-19 suggestive symptoms and imagistic changes and the result of the second RT-PCR test (AUC=0.683, CI 0.548–0.817), Panel C- ROC curve for the presence of lymphopenia at admission and the result of the first RTPCR test (AUC=0.527, CI 0.438–0.616), Panel D- ROC curve for the presence of lymphopenia at admission and the result of the second RT-PCR test (AUC=0.563, CI 0.412–0.713), Panel E- ROC curve for the value of ferritin at admission and the result of the first RT-PCR test (for a value >172ug/L, a sensitivity of 71% and a specificity of 55.5%, AUC=0.648, CI 0.551–0.746), Panel F- ROC curve for the value of ferritin at admission and the result of the second RT-PCR test (for a value >162.5ug/L, a sensitivity of 77.8% and a specificity of 56.1%, AUC=0.618, CI 0.464–0.771), Panel G- ROC curve for the maximum temperature during hospitalization and the result of the first RT-PCR test (for a value >37.3 Celsius grades, a sensitivity of 75% and a specificity of 66.2%, AUC=0.680, CI 0.533–0.827), Panel H- ROC curve for the maximum temperature during hospitalization and the result of the second RT-PCR test (for a value >37.5 Celsius grades, a sensitivity of 100% and a specificity of 76.8%, AUC=0.862, CI 0.795–0.929), Se-sensitivity, Sp-specificity.

Comparison between biological parameters in negative retested patients and positive patients.

Parameter Negative patients (mean ± standard deviation) Positive patients (mean ± standard deviation) P value
Admission hemoglobin level(g/dl) 13.62 ± 9.16 12.66 ± 2.35 0.4
Leukocytes at admission (×103/μl) 11.10 ± 4.53 10.54 ± 7.05 0.43
Neutrophils at admission (percent) (%) 73.73 ± 12.08 73.34 ± 11.16 0.81
Neutrophils at admission (absolute value) (×103/μl) 8.71 ± 5.94 7.25 ± 2.97 0.055
Lymphocyte at admission (percent) (%) 15.81 ± 8.62 16.36 ± 8.78 0.57
Lymphocyte at admission (absolute value) (×103/μl) 1.58 ± 0.88 1.5 ± 0.82 0.54
Monocyte at admission (percent) (%) 9.07 ± 8.12 8.7 ± 3.62 0.711
Monocyte at admission (absolute value) (×103/μl) 0.93 ± 0.65 0.91 ± 0.77 0.77
Leukocytes at 48h (×103/μl) 9.59 ± 3.42 9.65 ± 3.43 0.92
Neutrophils at 48h (percent) (%) 69.64 ± 10.17 71.48 ± 11.89 0.29
Neutrophils at 48h (absolute value) (×103/μl) 7.12 ± 5.17 7.13 ± 3.03 0.99
Lymphocyte at 48h (percent) (%) 18.22 ± 8.07 19.08 ± 12.97 0.57
Lymphocyte at 48h (absolute value) (×103/μl) 2.11 ± 3.59 1.59 ± 1.03 0.34
Monocyte at 48h (percent) (%) 9.62 ± 3.02 8.66 ± 3.26 0.06
Monocyte at 48h (absolute value) (×103/μl) 0.97 ± 0.91 0.84 ± 0.43 0.34
Highest Erythrocyte sedimentation rate (ESR) (mm/h) 31.07 ± 23.86 38.5 ± 23.74 0.042
Highest C-reactive protein (CRP) (mg/dl) 8.12 ± 9.24 12.21 ± 14.35 0.008
Highest Fibrinogen (mg/dl) 435.44 ± 160.71 448.44 ± 154.27 0.55
Ferritin (ug/L) 309.49 ± 435.33 377.22 ± 326.46 0.371
Highest Troponin I (ng/ml) 4647.97 ± 11089.05 2899.12 ± 5963.79 0.31
Admission NTproBNP (pg/ml) 4105.78 ± 7968.38 2623.6 ± 3993.31 0.27
Admission aspartate aminotransferase (AST) (mg/dl) 109.5 ± 335.36 55.24 ± 69.03 0.18
Admission alanine aminotransferase (ALT) (mg/dl) 68.2 ± 144.47 62.3 ± 134.07 0.76
Admission urea (BUN) (mg/dl) 57.66 ± 40.75 58.77 ± 40.28 0.84
Admission creatinine (mg/dl) 1.33 ± 1.23 1.59 ± 1.8 0.17
Admission eGFR (estimated glomerular filtration rate) (ml/min) 69.27 ± 30.78 66.11 ± 32.06 0.45
Glycated hemoglobin (HbA1c) (%) 6.59 ± 3.98 6.61 ± 1.18 0.97
Admission activated partial thromboplastin time (aPTT) (s) 36.65 ± 25.43 35.75 ± 15.78 0.78
Admission creatine kinase (CK) (U/L) 567.37 ± 1094.96 307.16 ± 530.52 0.06
Admission creatine kinase myocardial band (CK-MB) (U/L) 69.56 ± 132.41 26.85 ± 36.74 0.011
Admission lactate dehydrogenase (LDH) (U/L) 428.87 ± 420.59 320.05 ± 133.26 0.129

Multiple regression analysis for the result of the second RT-PCR test (positive/negative).

Pearson Coefficient of Correlation (R) Coefficient of determination (R2) P value Odds Ratio (OR)
Predictive model* 0.828 0.686 0.014 1.035

Comparison between demographic, electrocardiographic, echocardiographic, clinical and imagistic parameters in negative retested and positive patient.

Parameter Negative patients Positive patients P value
Age mean (years) 65.07 ± 14.24 66.57 ± 13.12 0.42
Age maximum (years) 92 95 NA
Age minimum (years) 28 31 NA
Demographic data Gender 34.1% female, 65.9% male 40% female, 60% male 0.35
Most frequent county of provenience 60.6% Bucharest (capital) 58.5% Bucharest (capital) NA
9.8% Giurgiu 8.6% Ilfov
7.6% Ilfov 7.1% Giurgiu
Atrial arrhythmias (%) 25% 35.7% 0.08
ECG parameters Ventricular arrhythmias (%) 8.8% 7.1% 0.6
Atrioventricular block 6.9% 10% 0.38
Mitral regurgitation 36.04% 30% 0.008
Mitral stenosis 0.7% 0 0.65
Aortic regurgitation 7.06% 4.28% 0.15
Echocardiographic parameters Aortic stenosis 8.83% 14.2% 0.56
LVEF mean (%) 39.47 ± 12.46% 41.72 ± 15.37% 0.2
LVEF reduced (<40%) 46.1% 37.5% 0.35
LVEF mid-range (≥40%, <50%) 24.3% 27.5% 0.41
LVEF preserved (≥50%) 29.6% 35% 0.18
Bronchial rales (%) 11.9% 11.4% 0.6
Crackles (%) 31.8% 25.7% 0.29
Low-grade fever (%) 25.7% 22.1% 0.54
High-grade fever (%) 7.3% 18.6% 0.004
Highest temperature during hospitalization (Celsius grades) 36.67 ± 2.79 37.47 ± 0.78 0.15
SaO2 (arterial oxygen saturation) (%) 93.95 ± 13.48 95.16 ± 3.47 0.56
Clinical parameters Cough (%) 34.8% 54.3% 0.003
Myalgia (%) 1.5% 8.6% 0.002
Dysphagia (%) 1.5% 1.4% 0.6
Ageusia/Anosmia (%) 0.4% 1.4% 0.72
Dyspnea (%) 54.5% 59.4% 0.47
Digestive symptoms (nausea, vomiting, diarrhea) (%) 1.1% 2.9% 0.29
Accentuation of the interstitial pattern on chest X-ray (%) 75.8% 81.4% 0.2
Pulmonary condensation or alveolitis on the chest X-Ray (%) 48.1% 44.3% 0.49
Pulmonary imaging Ground-glass image on thoracic CT scan (%) 6.4% 11.4% 0.06
Subpleural condensation on thoracic CT scan (%) 3.8% 10% 0.022
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