High Prevalence of Asymptomatic COVID-19 Infection in Hemodialysis Patients Detected Using Serologic Screening
High Prevalence of Asymptomatic COVID-19 Infection in Hemodialysis Patients Detected Using Serologic Screening
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DOI：
10.1681/asn.2020060827
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发表时间：
2020-09-01
影响因子：
13.6
通讯作者：
Willicombe, Michelle
中科院分区：
文献类型：
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作者：
Clarke, Candice;Prendecki, Maria;Willicombe, Michelle
背景在地球仪范围内，已迅速实施了旨在最大限度降低接受中心内血液透析的ESKD患者传播和获得COVID-19感染风险的策略。尽管采取了这些干预措施，但英国的确诊COVID-19感染率一直很高。尚未报告成人血液透析人群中无症状疾病的患病率。此外，据我们所知，对SARS-CoV-2的体液反应的发展以前没有在这一人群中报道过。尽管血清学检测不能提供患者感染性的信息，但血清阳性率研究可用于调查透析单位内的暴露情况，从而评估当前的筛查策略。方法采用Abbott IgG检测试剂盒，对356例血液透析患者的血清标本进行SARS-CoV-2抗体检测，以了解SARS-CoV-2抗体在血液透析人群中的阳性率。结果在356名患者中，121名在透析前筛查时有症状并接受了RT-PCR检测; 79名（占总研究人群的22.2%）COVID-19检测呈阳性。所有356例患者的血清学检测发现129例（36.2%）SARS-CoV-2抗体检测阳性。只有两名PCR证实感染的患者没有血清转化。在129例SARS-CoV-2抗体阳性患者中，52例（40.3%）无症状疾病或仅通过PCR检测未检出疾病。结论中心血液透析患者SARS-CoV-2抗体阳性率较高。无症状或PCR阴性患者既往感染的血清学证据表明，目前的诊断筛查策略在检测急性感染的能力方面可能有限。尽管采取了这些措施，但经RT-PCR检测证实的急性SARS-CoV-2感染率在联合王国一直很高。在中心血液透析成人人群中的血清阳性率以前没有报道过。在一项对356名接受中心血液透析的患者进行的研究中，作者报告了36.3%的血清阳性率。他们还发现，40.3%携带IgG SARS-CoV-2抗体的患者要么无症状感染，要么仅通过PCR检测未发现疾病。这些发现揭示了目前对透析前症状筛查的个体进行PCR检测的活动性SARS-CoV-2感染诊断筛查策略的局限性。有效的筛查可能需要PCR和血清学检测的混合策略。
Background Strategies to minimize the risk of transmission and acquisition of COVID-19 infection in patients with ESKD receiving in-center hemodialysis have been rapidly implemented across the globe. Despite these interventions, confirmed COVID-19 infection rates have been high in the United Kingdom. Prevalence of asymptomatic disease in an adult hemodialysis population has not been reported. Also, to our knowledge, the development of humoral response to SARS-CoV-2 has not been previously reported in this population. Although serologic testing does not provide information on the infectivity of patients, seroprevalence studies may enable investigation of exposure within dialysis units and hence, assessment of current screening strategies. Methods To investigate the seroprevalence of SARS-CoV-2 antibodies in a hemodialysis population, we used the Abbott IgG assay with the Architect system to test serum samples from 356 patients receiving in-center hemodialysis for SARS-CoV-2 antibodies. Results Of 356 patients, 121 had been symptomatic when screened before a dialysis session and received an RT-PCR test; 79 (22.2% of the total study population) tested positive for COVID-19. Serologic testing of all 356 patients found 129 (36.2%) who tested positive for SARS-CoV-2 antibodies. Only two patients with PCR-confirmed infection did not seroconvert. Of the 129 patients with SARS-CoV-2 antibodies, 52 (40.3%) had asymptomatic disease or undetected disease by PCR testing alone. Conclusions We found a high seroprevalence of SARS-CoV-2 antibodies in patients receiving in-center hemodialysis. Serologic evidence of previous infection in asymptomatic or PCR-negative patients suggests that current diagnostic screening strategies may be limited in their ability to detect acute infection.Significance Statement Strategies to limit acquisition and transmission of SARS-CoV-2 infection in patients with ESKD receiving in-center hemodialysis have been implemented globally. Despite these measures, acute SARS-CoV-2 infection rates confirmed by RT-PCR testing have been high in the United Kingdom. The seroprevalence rate in an in-center hemodialysis adult population has not been reported previously. In a study of 356 patients receiving in-center hemodialysis, the authors report a 36.3% seroprevalence rate. They also found that 40.3% of patients with IgG SARS-CoV-2 antibodies had either asymptomatic infection or undetected disease by PCR testing alone. These findings reveal limitations of current diagnostic screening strategies for active SARS-CoV-2 infection using PCR testing of individuals screened for symptoms prior to dialysis sessions. Effective screening is likely to require a hybrid strategy of PCR and serologic testing.