Üçüncü Basamak Sağlık Kuruluşuna Başvuran Hastalarda COVID-19 Serolojisinin İncelenmesi

Year 2023, , 83 - 88, 16.04.2023

Pelin Onarer , Tuğçe Ünalan-altıntop , Fikriye Milletli Sezgin

https://doi.org/10.46332/aemj.1061193

Abstract

Amaç: Hastanemize başvuran hastalarda PCR testi sonrası SARS-CoV-2 spesifik antikor bakılan hastalar retrospektif olarak taranıp, ilimizin serolojik profili hakkında fikir edinmek amaçlanmıştır.

Araçlar ve Yöntem: Laboratuvarımıza Ocak-Haziran 2021 tarihleri arasında, serum örneklerinde anti SARS-CoV-2 IgG ve/veya IgM çalışılan hastalar retrospektif olarak incelenip dahil edildi. Eş zamanlı olarak SARS-CoV-2 PCR testi uygulandı.

Bulgular: 725 hastanın 123’üne IgM veya IgG olmak üzere yalnızca bir istem yapılmış, 602 kişiye ise IgM ve IgG birlikte istenmişti. PCR testi ile anti SARS-CoV-2 IgG ve/veya IgM istemleri arasında 30 gün süre bulunan hastalara bakıldığında ise toplam 304 (%42) hastanın 40 (%13)’ının PCR testi pozitif olarak saptanmıştır, bu hastaların 60%’ının 30 gün içindeki IgM ve IgG iki testi birlikte pozitif olarak bulunmuştur. PCR testi negatif 264 hastadan %64’ünün IgM ve IgG testi negatif bulunmuştur. Sonuçlarımıza göre, testlerin %58’i PCR istemi olmadan istenmiştir. PCR ve seroloji istemleri arasındaki süreler incelendiğinde ilk 7 gün içerisinde 233 (%76.6) seroloji istemi, 8-14 gün içinde 27 (%8.8), 15-21 gün içinde 7 (%2.3), 22-30 gün içinde 37 (%12.3) istem yapıldığı görülmüştür. 117 (%38.5) istemde PCR ve serolojinin aynı anda yapıldığı saptanmıştır.

Sonuç: DSÖ serolojik test istemlerinin PCR testinden sonraki 1. ve 3-4. haftalarda yapılmasını önermektedir. Hastanemizde yüksek oranda uygun olmayan istem yapıldığı görülmekte olup bu durum serolojik test istem algoritma eksikliğini göstermektedir. Serolojik testlerin COVID19 hastalığının tanısında tek başına kullanımı değil; nükleik asit testleriyle birlikte ve onlara yardımcı olarak kullanımı önerilmektedir. Bu durum bize aşı sonrası antikor yanıtını görmek için gereksiz test istemine yol açıldığını düşündürmüştür.

Keywords

COVID19, PCR, IgG, IgM, CLIA

Investigation of COVID-19 Serology in a Tertiary Care Center

Abstract

Purpose: This study aimed to screen the patients admitted to our hospital for SARS-CoV-2 specific antibodies after a PCR test and understand the local serological profile.

Materials and Methods: The patients tested for anti-SARS-CoV-2 IgG and/or IgM between January-June 2021 were included in the study. SARS-CoV-2 PCR test was performed simultaneously.

Results: Either IgM or IgG alone was requested in 123 of 725 patients, and IgM and IgG together in 602. The PCR test was positive in 40 (13%) of 304 (42%) patients who had a PCR test after 30 days of the serology request. Of these PCR-positive patients, 60% had IgM and IgG antibodies together, whereas among 204 PCR-negative patients, 64% tested negative for IgM and IgG. 58% of the tests were ordered without a PCR request. The period between PCR and serology testing was as follows: 233 (76.6%) in 7 days, 27 (8.8%) in 8-14 days, 7 (2.3%) in 15-21 days, and 37 (12.3%) in 22-30 days. 117 (38.5%) of the requests were made simultaneously.

Conclusion: WHO recommends that serology testing should be performed after the 1st and 3-4th week of the initial PCR test. The high rate of inappropriate testing demonstrates a lack of algorithms. The use of serological tests is recommended in conjunction with nucleic acid tests but not to be used alone in the diagnosis of COVID-19. Our results demonstrated the high rate of unnecessary requests for serology testing to determine the antibody response against SARS-CoV-2 vaccines.

Keywords

COVID19, PCR, IgG, IgM, CLIA

References

• 1. Su S, Wong G, Shi W, et al. Epidemiology, Genetic Recombination, and Pathogenesis of Coronaviruses. Trends Microbiol. 2016;24(6):490-502.
• 2. De Wit E, Van Doremalen N, Falzarano D, Munster VJ. SARS and MERS: Recent insights into emerging coronaviruses. Nat Rev Microbiol. 2016;14(8):523-534.
• 3. Zhang YZ, Holmes EC. A genomic perspective on the origin and emergence of SARS-CoV-2. Cell. 2020;181(2):223-227.
• 4. Li X, Zai J, Zhao Q, et al. Evolutionary history, potential intermediate animal host, and cross-species analyses of SARS-CoV-2. J Med Virol. 2020;92(6):602-611.
• 5. World Health Organisation. Dünya Sağlık Örgütü. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.Access date 18 December, 2021.
• 6. BMJ Best Practice. https://bestpractice.bmj.com/topics/en-gb/3000201/aetiology. Access date 18 December, 2021.
• 7. Bozdayı G, Çağlar K, Fidan I. COVID-19 Pandemisi: Tıbbi Viroloji Laboratuvarının Rolü. GMJ. 2020;31:251-254.
• 8. Krajewski R, Gołębiowska J, Makuch S, Mazur G, Agrawal S. Update on serologic testing in COVID–19. Clinica Chimica Acta. 2020;510:746-750.
• 9. Erensoy S. COVID-19 Pandemisinde SARS-CoV-2 ve Mikrobiyolojik Tanı Dinamikleri. Mikrobiyol Bul. 2020;54(3):497-509.
• 10. Ong D.S.Y, Fragkou P.C, Schweitzer V.A, et al. How to interpret and use COVID-19 serology and immunology tests. Clin Microbiol Infect. 2021;27(7):981-986.
• 11. Zhao J, Yuan Q, Wang H, et al. Antibody responses to SARS-COV-2 in patients of novel Coronavirus disease 2019. Clin Infect Dis. 2020;71(16):2027-2034.
• 12. Winter A.K, Hegde S.D. The important role of serology for COVID-19 control. Lancet Infect Dis. 2020;20 (7):758-759.
• 13. Durmaz B. Microbiological Diagnosis in Covid-19 Infection. YIU Saglik Bil Derg. 2020;1:12-17.
• 14. Patel R, Babady E, Theel E, et al. Report from the American Society for Microbiology COVID-19 International Summit, 23 March 2020: Value of Diagnostic Testing for SARS-CoV-2/COVID-19. MBio. 2020;11(2):1-5.
• 15. Walls A.C, Park Y.-J, Tortorici M.A, et al. Structure, function, and antigenicity of the SARS–CoV–2 spike glycoprotein. Cell. 2020;180(2):281-292.
• 16. Tang Y.W, Schmitz J.E, Persing D.H, Stratton C.W. Laboratory Diagnosis of COVID-19: Current Issues and Challenges. J. Clin. Microbiol. 2020;58(6):512-520.
• 17. Guo L, Ren L, Yang S, et al. Profiling early humoral response to diagnose novel coronavirus disease (COVID-19). Clin Infect Dis. 2020;71(15):778-785.
• 18. Long Q.X, Liu B.Z, Deng H.J, et al. Antibody responses to SARS-CoV-2 in patients with COVID-19. Nature Medicine. 2020;26(6):845-848.
• 19. Sethuraman N, Jeremiah SS, Ryo A. Interpreting diagnostic tests for SARS-CoV-2. JAMA. 2020;323 (22):2249-2251.
• 20. Lu H, Stratton CW, Tang YW. An evolving approach to the laboratory assessment of COVID-19. J Med Virol. 2020;92(10):1812-1817.
• 21. Zhong L, Chuan J, Gong B, et al. Detection of serum IgM and IgG for COVID-19 diagnosis. Sci China Life Sci. 2020;63(5):777-780.
• 22. Peeling R.W, Wedderburn C.J, Garcia P.J, et al. Serology testing in the COVID-19 pandemic response. Lancet Infect Dis 2020;20(9):e245-e249.
• 23. Chen L, Xiong J, Bao L, Shi Y. Convalescent plasma as a potential therapy for COVID-19. Lancet Infect Dis 2020;20(4):398-400.
• 24. Li Z, Yi Y, Luo X, et al. Development and clinical application of a rapid IgM‐IgG combined antibody test for SARS‐CoV‐2 infection diagnosis. J. Med. Virol. 2020;92(9):1518-1524.
• 25. Lou B, Li T.D, Zheng S.F, et al. Serology characteristics of SARS–CoV–2 infection since the exposure and post symptoms onset. Eur Respir J. 2020;56(2): 2000763.
• 26. Sun B, Feng Y, Mo X, et al. Kinetics of SARS–CoV–2 specific IgM and IgG responses in COVID–19 patients. Emerg. Microbes Infect. 2020;9(1):940-948.
• 27. World Health Organisation. Dünya Sağlık Örgütü. Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases. 2020. Access date 18 December, 2021.
• 28. Kelvin Kai-Wang To, Owen Tak-Yin Tsang, Wai-Shing Leung, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS–CoV–2: an observational cohort study. Lancet Infect. Dis. 2020;20(5):565-574.
• 29. Chen X, Zhou B, Li M, et al. Serology of severe acute respiratory syndrome: implications for surveillance and outcome. J Infect Dis. 2004;189(7):1158-1163.
• 30. Haveri A, Smura T, Kuivanen S, et al. Serological and molecular findings during SARS–CoV–2 infection: the first case study in Finland, January to February 2020, Euro Surveill. 2020;25(11):2000266.