Results of an early second PCR test performed on SARS-CoV-2 positive patients may support risk assessment for severe COVID-19

  1. Barak Mizrahi
  2. Maytal Bivas-Benita
  3. Nir Kalkstein
  4. Pinchas Akiva
  5. Chen Yanover
  6. Yoav Yehezkelli
  7. Yoav Kessler
  8. Sharon Hermoni Alon
  9. Eitan Rubin
  10. Gabriel Chodick

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Abstract

Identifying patients at increased risk for severe COVID-19 is of high priority during the pandemic as it could affect clinical management and shape public health guidelines. In this study we assessed whether a second PCR test conducted 2–7 days after a SARS-CoV-2 positive test could identify patients at risk for severe illness. Analysis of a nationwide electronic health records data of 1683 SARS-CoV-2 positive individuals indicated that a second negative PCR test result was associated with lower risk for severe illness compared to a positive result. This association was seen across different age groups and clinical settings. More importantly, it was not limited to recovering patients but also observed in patients who still had evidence of COVID-19 as determined by a subsequent positive PCR test. Our study suggests that an early second PCR test may be used as a supportive risk-assessment tool to improve disease management and patient care.

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  1. ScreenIT

    SciScore for 10.1101/2021.02.09.21251371: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data: Data in this study originated from Maccabi Healthcare Services (MHS) which is the second largest active HMO in Israel.
    Maccabi Healthcare
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study also has several limitations. First, we were unable to determine what was the reason for the multiple PCR tests performed by the individuals. The additional tests were not done by all SARS-CoV-2 positive patients documented in Maccabi Health Services. Within the week following a positive test we had results of a second PCR test for 10% of the patients 18-59 years old, 14% for ages 60-79 and 32% for patients older than 80. To control for a potential bias, we also analyzed all the patients who tested positive and did not have an early second PCR test. Their risk for severe condition was in the range of those who tested positive/negative the second time within a week from diagnosis. Second, the guidelines for COVID-19 testing in Israel had changed several times during the study period and the inconsistent reasons and frequency for SARS-CoV-2 PCR testing may affect our results. In conclusion, this study explored a new application for multiple SARS CoV-2 PCR testing. While current multiple testing approaches aim to detect COVID-19 early, prevent transmission, contain it and reduce morbidity and mortality, we suggest that additional PCR testing is used in the clinic as an early, wide-spread complementary tool for risk assessment and subsequent appropriate disease management. This could direct appropriate resources and guide clinical testing and isolation of patients at risk.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1038/s41598-021-99671-5
  3. Version published to 10.1101/2021.02.09.21251371 on medRxiv