At what times during infection is SARS-CoV-2 detectable and no longer detectable using RT-PCR-based tests? A systematic review of individual participant data.
At what times during infection is SARS-CoV-2 detectable and no longer detectable using RT-PCR-based tests? A systematic review of individual participant data.
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在感染期间，什么时候可以检测到SARS-COV-2，并且不再使用基于RT-PCR的测试检测到？对个别参与者数据的系统审查。
DOI：
10.1186/s12916-020-01810-8
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发表时间：
2020-11-04
期刊：
影响因子：
9.3
通讯作者：
Halligan S
中科院分区：
文献类型：
--
作者：
Mallett S;Allen AJ;Graziadio S;Taylor SA;Sakai NS;Green K;Suklan J;Hyde C;Shinkins B;Zhelev Z;Peters J;Turner PJ;Roberts NW;di Ruffano LF;Wolff R;Whiting P;Winter A;Bhatnagar G;Nicholson BD;Halligan S
使用逆转录聚合酶链反应（RT-PCR）检测严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）病毒核糖核酸（RNA）是检测当前冠状病毒疾病（COVID-19）和可检测病毒持续时间（表明潜在传染性）的关键。我们对症状性SARS-CoV-2的RT-PCR检测结果的纵向研究进行了个体参与者数据（IPD）系统回顾。我们检索了PubMed、LitCOVID、medRxiv和COVID-19 Living Evidence数据库。我们使用QUADAS-2适应评估偏倚风险。结果是按时间和可检测病毒的持续时间，按解剖学采样部位划分的阳性检测结果的百分比。在筛选的5078项研究中，我们纳入了32项研究，其中包括1023名SARS-CoV-2感染的参与者和1619个测试结果，从症状发作和住院后的-6至66天。病毒检测百分比最高的是症状出现后0至4天之间的鼻咽采样，为89%（95%置信区间（CI）83至93），10至14天后降至54%（95% CI 47至61）。平均而言，下呼吸道（LRT）采样的可检测病毒持续时间长于上呼吸道（URT）。粪便和呼吸道病毒检测的持续时间在个体参与者中差异很大。在一些参与者中，病毒在症状发作后46天仍可检测到。RT-PCR未能检测到SARS-CoV-2感染者;早期采样可最大限度地减少假阴性诊断。症状发作后超过10天，较低的RT或粪便检测可能是首选的采样点。纳入的研究存在大量偏倚风险，因此阳性率可能被高估。
Tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral ribonucleic acid (RNA) using reverse transcription polymerase chain reaction (RT-PCR) are pivotal to detecting current coronavirus disease (COVID-19) and duration of detectable virus indicating potential for infectivity. We conducted an individual participant data (IPD) systematic review of longitudinal studies of RT-PCR test results in symptomatic SARS-CoV-2. We searched PubMed, LitCOVID, medRxiv, and COVID-19 Living Evidence databases. We assessed risk of bias using a QUADAS-2 adaptation. Outcomes were the percentage of positive test results by time and the duration of detectable virus, by anatomical sampling sites. Of 5078 studies screened, we included 32 studies with 1023 SARS-CoV-2 infected participants and 1619 test results, from − 6 to 66 days post-symptom onset and hospitalisation. The highest percentage virus detection was from nasopharyngeal sampling between 0 and 4 days post-symptom onset at 89% (95% confidence interval (CI) 83 to 93) dropping to 54% (95% CI 47 to 61) after 10 to 14 days. On average, duration of detectable virus was longer with lower respiratory tract (LRT) sampling than upper respiratory tract (URT). Duration of faecal and respiratory tract virus detection varied greatly within individual participants. In some participants, virus was still detectable at 46 days post-symptom onset. RT-PCR misses detection of people with SARS-CoV-2 infection; early sampling minimises false negative diagnoses. Beyond 10 days post-symptom onset, lower RT or faecal testing may be preferred sampling sites. The included studies are open to substantial risk of bias, so the positivity rates are probably overestimated.
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