Exploration of turn-positive RT-PCR results and factors related to treatment outcome in COVID-19: A retrospective cohort study

The cause of some patients with negative RT-PCR results experienced turn-positive after treatment remains unclear. In addition, understanding the correlation between changes in clinical data in the course of COVID-19 and treatment outcomes is of great importance in determining the prognosis of COVID-19. To perform cause analysis of RT-PCR turn-positive and the effective screening factors related to treatment outcome in COVID-19. Clinical data, including clinical manifestations, laboratory tests, radiography results, treatment methods and outcomes, were retrospectively collected and analyzed from January to March 2020 in Renmin Hospitals of Wuhan University. 116 COVID-19 patients (40 in recurrent group, 29 in recovered group and 47 in unrecovered group) were recruited. In the recurrent group, white blood cell, Neutrophils, prothrombin time, activated partial thromboplastin time, CD3, CD4, CD8, ratio of CD4/CD8, IgG and C4 complement were of significant difference among the baseline, negative and turn-positive time points. CD19 and CT scan results were found notable difference between recurrent group and recovered group. Odds from CD3, CD4, CD8, CD19, IgM, C3 complement, C4 complement and CT scan results validated associations with clinical outcomes of COVID-19. The so-called recurrence in some COVID-19 patients may be due to the false-negative of nucleic acid test results from nasopharyngeal swabs. Levels of CD3, CD4, CD8, CD19, IgM, C3 complement, C4 complement and CT results were significantly correlated with the outcome of COVID-19. The cellular immunity test could be beneficial to further screen the reliability of RT-PCR test on the basis of CT images.

部分新冠患者经治疗后，新冠病毒核酸逆转录聚合酶链反应（RT-PCR）检测结果由阴转阳，其具体病因目前仍不明确。此外，明确新冠病程中临床数据变化与治疗结局之间的关联，对于判断新冠患者的预后具有重要意义。本研究旨在分析新冠患者RT-PCR复阳的病因，并筛选与新冠治疗结局相关的有效筛查因子。本研究回顾性收集并分析了武汉大学人民医院2020年1月至3月期间的临床数据，涵盖临床表现、实验室检查、电子计算机断层扫描（CT）结果、治疗方案及治疗结局等内容，最终纳入116例新冠患者，其中复阳组40例、康复组29例、未康复组47例。在复阳组中，基线、首次核酸转阴、复阳三个时间点的白细胞计数、中性粒细胞、凝血酶原时间、活化部分凝血活酶时间、CD3、CD4、CD8、CD4/CD8比值、IgG及补体C4水平存在显著差异；复阳组与康复组相比，CD19水平及CT扫描结果存在显著差异。CD3、CD4、CD8、CD19、IgM、补体C3、补体C4水平及CT扫描结果相关的比值比均证实与新冠患者的临床结局存在关联。部分新冠患者所谓的"复阳"，可能源于鼻咽拭子核酸检测出现假阴性结果。CD3、CD4、CD8、CD19、IgM、补体C3、补体C4水平及CT检查结果均与新冠患者的治疗结局显著相关。在CT影像学检查的基础上联合细胞免疫检测，有助于进一步评估RT-PCR检测结果的可靠性。