Üçüncü Basamak Sağlık Kuruluşuna Başvuran Hastalarda COVID-19 Serolojisinin İncelenmesi

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. 1. Su S, Wong G, Shi W, et al. Epidemiology, Genetic Recombination, and Pathogenesis of Coronaviruses. Trends Microbiol. 2016;24(6):490-502.
2. 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. 3. Zhang YZ, Holmes EC. A genomic perspective on the origin and emergence of SARS-CoV-2. Cell. 2020;181(2):223-227.
4. 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. 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. 6. BMJ Best Practice. https://bestpractice.bmj.com/topics/en-gb/3000201/aetiology. Access date 18 December, 2021.
7. 7. Bozdayı G, Çağlar K, Fidan I. COVID-19 Pandemisi: Tıbbi Viroloji Laboratuvarının Rolü. GMJ. 2020;31:251-254.
8. 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. 9. Erensoy S. COVID-19 Pandemisinde SARS-CoV-2 ve Mikrobiyolojik Tanı Dinamikleri. Mikrobiyol Bul. 2020;54(3):497-509.
10. 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. 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. 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. 13. Durmaz B. Microbiological Diagnosis in Covid-19 Infection. YIU Saglik Bil Derg. 2020;1:12-17.
14. 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. 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. 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. 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. 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. 19. Sethuraman N, Jeremiah SS, Ryo A. Interpreting diagnostic tests for SARS-CoV-2. JAMA. 2020;323 (22):2249-2251.
20. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.