Positive rate of RT-PCR detection of SARS-CoV-2 infection in 4880 cases from one hospital in Wuhan, China, from Jan to Feb 2020
Identifieur interne : 000833 ( Pmc/Corpus ); précédent : 000832; suivant : 000834Positive rate of RT-PCR detection of SARS-CoV-2 infection in 4880 cases from one hospital in Wuhan, China, from Jan to Feb 2020
Auteurs : Rui Liu ; Huan Han ; Fang Liu ; Zhihua Lv ; Kailang Wu ; Yingle Liu ; Yong Feng ; Chengliang ZhuSource :
- Clinica Chimica Acta; International Journal of Clinical Chemistry [ 0009-8981 ] ; 2020.
Abstract
The SARS-CoV-2 NAT positive rate was about 38% for the total 4880 specimens. Male and older population had a significant higher positive rates. 57% was positive among the specimens from the Fever Clinics. Age, not gender, was the risk factor for SARS-CoV-2 infection in fever clinics. Viral NAT played an important role in identifying SARS-CoV-2 infection.
Url:
DOI: 10.1016/j.cca.2020.03.009
PubMed: 32156607
PubMed Central: 7094385
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Positive rate of RT-PCR detection of SARS-CoV-2 infection in 4880 cases from one hospital in Wuhan, China, from Jan to Feb 2020</title><author><name sortKey="Liu, Rui" sort="Liu, Rui" uniqKey="Liu R" first="Rui" last="Liu">Rui Liu</name><affiliation><nlm:aff id="af005">Dept. of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China</nlm:aff></affiliation></author><author><name sortKey="Han, Huan" sort="Han, Huan" uniqKey="Han H" first="Huan" last="Han">Huan Han</name><affiliation><nlm:aff id="af005">Dept. of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China</nlm:aff></affiliation></author><author><name sortKey="Liu, Fang" sort="Liu, Fang" uniqKey="Liu F" first="Fang" last="Liu">Fang Liu</name><affiliation><nlm:aff id="af010">Dept.State Key Laboratory of Virology (Wuhan University), College of Life Sciences of Wuhan University, Wuhan 430072, Hubei, China</nlm:aff></affiliation><affiliation><nlm:aff id="af015">Dept.Wuhan Institute of Biotechnology, Wuhan 430075, Hubei, China</nlm:aff></affiliation></author><author><name sortKey="Lv, Zhihua" sort="Lv, Zhihua" uniqKey="Lv Z" first="Zhihua" last="Lv">Zhihua Lv</name><affiliation><nlm:aff id="af005">Dept. of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China</nlm:aff></affiliation></author><author><name sortKey="Wu, Kailang" sort="Wu, Kailang" uniqKey="Wu K" first="Kailang" last="Wu">Kailang Wu</name><affiliation><nlm:aff id="af010">Dept.State Key Laboratory of Virology (Wuhan University), College of Life Sciences of Wuhan University, Wuhan 430072, Hubei, China</nlm:aff></affiliation></author><author><name sortKey="Liu, Yingle" sort="Liu, Yingle" uniqKey="Liu Y" first="Yingle" last="Liu">Yingle Liu</name><affiliation><nlm:aff id="af010">Dept.State Key Laboratory of Virology (Wuhan University), College of Life Sciences of Wuhan University, Wuhan 430072, Hubei, China</nlm:aff></affiliation></author><author><name sortKey="Feng, Yong" sort="Feng, Yong" uniqKey="Feng Y" first="Yong" last="Feng">Yong Feng</name><affiliation><nlm:aff id="af020">School of Basic Medical Sciences, Wuhan University, Wuhan 430071, Hubei, China</nlm:aff></affiliation></author><author><name sortKey="Zhu, Chengliang" sort="Zhu, Chengliang" uniqKey="Zhu C" first="Chengliang" last="Zhu">Chengliang Zhu</name><affiliation><nlm:aff id="af005">Dept. of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32156607</idno><idno type="pmc">7094385</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7094385</idno><idno type="RBID">PMC:7094385</idno><idno type="doi">10.1016/j.cca.2020.03.009</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000833</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000833</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Positive rate of RT-PCR detection of SARS-CoV-2 infection in 4880 cases from one hospital in Wuhan, China, from Jan to Feb 2020</title><author><name sortKey="Liu, Rui" sort="Liu, Rui" uniqKey="Liu R" first="Rui" last="Liu">Rui Liu</name><affiliation><nlm:aff id="af005">Dept. of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China</nlm:aff></affiliation></author><author><name sortKey="Han, Huan" sort="Han, Huan" uniqKey="Han H" first="Huan" last="Han">Huan Han</name><affiliation><nlm:aff id="af005">Dept. of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China</nlm:aff></affiliation></author><author><name sortKey="Liu, Fang" sort="Liu, Fang" uniqKey="Liu F" first="Fang" last="Liu">Fang Liu</name><affiliation><nlm:aff id="af010">Dept.State Key Laboratory of Virology (Wuhan University), College of Life Sciences of Wuhan University, Wuhan 430072, Hubei, China</nlm:aff></affiliation><affiliation><nlm:aff id="af015">Dept.Wuhan Institute of Biotechnology, Wuhan 430075, Hubei, China</nlm:aff></affiliation></author><author><name sortKey="Lv, Zhihua" sort="Lv, Zhihua" uniqKey="Lv Z" first="Zhihua" last="Lv">Zhihua Lv</name><affiliation><nlm:aff id="af005">Dept. of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China</nlm:aff></affiliation></author><author><name sortKey="Wu, Kailang" sort="Wu, Kailang" uniqKey="Wu K" first="Kailang" last="Wu">Kailang Wu</name><affiliation><nlm:aff id="af010">Dept.State Key Laboratory of Virology (Wuhan University), College of Life Sciences of Wuhan University, Wuhan 430072, Hubei, China</nlm:aff></affiliation></author><author><name sortKey="Liu, Yingle" sort="Liu, Yingle" uniqKey="Liu Y" first="Yingle" last="Liu">Yingle Liu</name><affiliation><nlm:aff id="af010">Dept.State Key Laboratory of Virology (Wuhan University), College of Life Sciences of Wuhan University, Wuhan 430072, Hubei, China</nlm:aff></affiliation></author><author><name sortKey="Feng, Yong" sort="Feng, Yong" uniqKey="Feng Y" first="Yong" last="Feng">Yong Feng</name><affiliation><nlm:aff id="af020">School of Basic Medical Sciences, Wuhan University, Wuhan 430071, Hubei, China</nlm:aff></affiliation></author><author><name sortKey="Zhu, Chengliang" sort="Zhu, Chengliang" uniqKey="Zhu C" first="Chengliang" last="Zhu">Chengliang Zhu</name><affiliation><nlm:aff id="af005">Dept. of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China</nlm:aff></affiliation></author></analytic><series><title level="j">Clinica Chimica Acta; International Journal of Clinical Chemistry</title><idno type="ISSN">0009-8981</idno><idno type="eISSN">1873-3492</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Highlights</title><p><list list-type="simple" id="l0005"><list-item id="o0005"><label>•</label><p id="p0005">The SARS-CoV-2 NAT positive rate was about 38% for the total 4880 specimens. Male and older population had a significant higher positive rates.</p></list-item><list-item id="o0010"><label>•</label><p id="p0010">57% was positive among the specimens from the Fever Clinics. Age, not gender, was the risk factor for SARS-CoV-2 infection in fever clinics.</p></list-item><list-item id="o0015"><label>•</label><p id="p0015">Viral NAT played an important role in identifying SARS-CoV-2 infection.</p></list-item></list></p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Fang, Y" uniqKey="Fang Y">Y. Fang</name></author><author><name sortKey="Zhang, H" uniqKey="Zhang H">H. Zhang</name></author><author><name sortKey="Xie, J" uniqKey="Xie J">J. Xie</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Xie, X" uniqKey="Xie X">X. Xie</name></author><author><name sortKey="Zhong, Z" uniqKey="Zhong Z">Z. Zhong</name></author><author><name sortKey="Zhao, W" uniqKey="Zhao W">W. Zhao</name></author><author><name sortKey="Zheng, C" uniqKey="Zheng C">C. Zheng</name></author><author><name sortKey="Wang, F" uniqKey="Wang F">F. Wang</name></author><author><name sortKey="Liu, J" uniqKey="Liu J">J. Liu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Li, Q" uniqKey="Li Q">Q. Li</name></author><author><name sortKey="Guan, X" uniqKey="Guan X">X. Guan</name></author><author><name sortKey="Wu, P" uniqKey="Wu P">P. Wu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Huang, C" uniqKey="Huang C">C. Huang</name></author><author><name sortKey="Wang, Y" uniqKey="Wang Y">Y. Wang</name></author><author><name sortKey="Li, X" uniqKey="Li X">X. Li</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zhu, N" uniqKey="Zhu N">N. Zhu</name></author><author><name sortKey="Zhang, D" uniqKey="Zhang D">D. Zhang</name></author><author><name sortKey="Wang, W" uniqKey="Wang W">W. Wang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wang, D" uniqKey="Wang D">D. Wang</name></author><author><name sortKey="Hu, B" uniqKey="Hu B">B. Hu</name></author><author><name sortKey="Hu, C" uniqKey="Hu C">C. Hu</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Chen, N" uniqKey="Chen N">N. Chen</name></author><author><name sortKey="Zhou, M" uniqKey="Zhou M">M. Zhou</name></author><author><name sortKey="Dong, X" uniqKey="Dong X">X. Dong</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin Chim Acta</journal-id><journal-id journal-id-type="iso-abbrev">Clin. Chim. Acta</journal-id><journal-title-group><journal-title>Clinica Chimica Acta; International Journal of Clinical Chemistry</journal-title></journal-title-group><issn pub-type="ppub">0009-8981</issn><issn pub-type="epub">1873-3492</issn><publisher><publisher-name>Elsevier</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32156607</article-id><article-id pub-id-type="pmc">7094385</article-id><article-id pub-id-type="publisher-id">S0009-8981(20)30112-1</article-id><article-id pub-id-type="doi">10.1016/j.cca.2020.03.009</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Positive rate of RT-PCR detection of SARS-CoV-2 infection in 4880 cases from one hospital in Wuhan, China, from Jan to Feb 2020</article-title></title-group><contrib-group><contrib contrib-type="author" id="au005"><name><surname>Liu</surname><given-names>Rui</given-names></name><xref rid="af005" ref-type="aff">a</xref><xref rid="fn1" ref-type="fn">1</xref></contrib><contrib contrib-type="author" id="au010"><name><surname>Han</surname><given-names>Huan</given-names></name><xref rid="af005" ref-type="aff">a</xref><xref rid="fn1" ref-type="fn">1</xref></contrib><contrib contrib-type="author" id="au015"><name><surname>Liu</surname><given-names>Fang</given-names></name><xref rid="af010" ref-type="aff">b</xref><xref rid="af015" ref-type="aff">c</xref></contrib><contrib contrib-type="author" id="au020"><name><surname>Lv</surname><given-names>Zhihua</given-names></name><xref rid="af005" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au025"><name><surname>Wu</surname><given-names>Kailang</given-names></name><xref rid="af010" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="au030"><name><surname>Liu</surname><given-names>Yingle</given-names></name><xref rid="af010" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="au035"><name><surname>Feng</surname><given-names>Yong</given-names></name><email>yongfeng@whu.edu.cn</email><xref rid="af020" ref-type="aff">d</xref><xref rid="cor1" ref-type="corresp">⁎</xref></contrib><contrib contrib-type="author" id="au040"><name><surname>Zhu</surname><given-names>Chengliang</given-names></name><email>xinchengzhu@163.com</email><xref rid="af005" ref-type="aff">a</xref><xref rid="cor1" ref-type="corresp">⁎</xref></contrib></contrib-group><aff id="af005"><label>a</label>Dept. of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China</aff><aff id="af010"><label>b</label>Dept.State Key Laboratory of Virology (Wuhan University), College of Life Sciences of Wuhan University, Wuhan 430072, Hubei, China</aff><aff id="af015"><label>c</label>Dept.Wuhan Institute of Biotechnology, Wuhan 430075, Hubei, China</aff><aff id="af020"><label>d</label>School of Basic Medical Sciences, Wuhan University, Wuhan 430071, Hubei, China</aff><author-notes><corresp id="cor1"><label>⁎</label>Corresponding author. <email>yongfeng@whu.edu.cn</email><email>xinchengzhu@163.com</email></corresp><fn id="fn1"><label>1</label><p id="np010">These authors contribute equally to this study.</p></fn></author-notes><pub-date pub-type="pmc-release"><day>7</day><month>3</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>7</day><month>3</month><year>2020</year></pub-date><elocation-id></elocation-id><history><date date-type="received"><day>2</day><month>3</month><year>2020</year></date><date date-type="accepted"><day>6</day><month>3</month><year>2020</year></date></history><permissions><copyright-statement>© 2020 Elsevier B.V. All rights reserved.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder></copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract abstract-type="author-highlights" id="ab005"><title>Highlights</title><p><list list-type="simple" id="l0005"><list-item id="o0005"><label>•</label><p id="p0005">The SARS-CoV-2 NAT positive rate was about 38% for the total 4880 specimens. Male and older population had a significant higher positive rates.</p></list-item><list-item id="o0010"><label>•</label><p id="p0010">57% was positive among the specimens from the Fever Clinics. Age, not gender, was the risk factor for SARS-CoV-2 infection in fever clinics.</p></list-item><list-item id="o0015"><label>•</label><p id="p0015">Viral NAT played an important role in identifying SARS-CoV-2 infection.</p></list-item></list></p></abstract><abstract id="ab010"><sec><title>Background</title><p>There’s an outbreak of a novel coronavirus (SARS-CoV-2) infection since December 2019, first in China, and currently with more than 80 thousand confirmed infection globally in 29 countries till March 2, 2020. Identification, isolation and caring for patients early are essential to limit human-to-human transmission including reducing secondary infections among close contacts and health care workers, preventing transmission amplification events. The RT-PCR detection of viral nucleic acid test (NAT) was one of the most quickly established laboratory diagnosis method in a novel viral pandemic, just as in this COVID-19 outbreak.</p></sec><sec><title>Methods</title><p>4880 cases that had respiratory infection symptoms or close contact with COVID-19 patients in hospital in Wuhan, China, were tested for SARS-CoV-2 infection by use of quantitative RT-PCR (qRT-PCR) on samples from the respiratory tract. Positive rates were calculated in groups divided by genders or ages.</p></sec><sec><title>Results</title><p>The positive rate was about 38% for the total 4880 specimens. Male and older population had a significant higher positive rates. However, 57% was positive among the specimens from the Fever Clinics. Binary logistic regression analysis showed that age, not gender, was the risk factor for SARS-CoV-2 infection in fever clinics.</p></sec><sec><title>Conclusions</title><p>Therefore, we concluded that viral NAT played an important role in identifying SARS-CoV-2 infection.</p></sec></abstract></article-meta></front><body><sec id="s0005"><label>1</label><title>Introduction</title><p id="p0020">Since December 2019, an epidemic Coronavirus disease (COVID-19) caused by novel coronavirus (SARS-CoV-2) infection has occurred unexpectedly in China. Till March 2, 2020, more than 80 thousand confirmed cases have been reported in China. Of these cases, 49 thousand were identified in Wuhan City. Identification, isolation and caring for patients early are essential to limit human-to-human transmission including reducing secondary infections among close contacts and health care workers, preventing transmission amplification events. Following the national recommendations for diagnosis and treatment of pneumonia caused by 2019-nCoV (the 5th edition) and current status of clinical practice in Hubei Province, RT-PCR analysis was used to detect the causative virus from respiratory secretions. However, some investigators and clinical doctors argued that CT imaging should be served to identify the SARS-CoV-2 infection instead, since quite a bit cases showed progressive multiple peripheral ground-glass opacities in both lungs even the RT-PCR results were negative<xref rid="b0005" ref-type="bibr">[1]</xref>, <xref rid="b0010" ref-type="bibr">[2]</xref>.</p><p id="p0025">Since RT-PCR was one of the most quickly established laboratory diagnosis method in a novel viral pandemic, just as this COVID-19, it served efficiently to confirm a viral infection within 2 hours. During the early Feb, the need of detect increased dramatically up to 10 thousands of samples per day in Wuhan City. But to what extend was this RT-PCR based viral nucleic acid test (NAT) could reflect the real SARS-CoV-2 infection?</p><p id="p0030">Therefore in this study, we retrospectively analysed NAT test of 4880 cases from Jan 22 to Feb 14, 2020 in Renmin Hospital of Wuhan University. All the cases were suspected of SARS-CoV-2 infection because of, 1) typical respiratory infection symptoms such as fever, cough and dyspnoea, or 2) close contact with a COVID-19 patient. RT-PCR were performed to detect ORF1ab and NP genes fragments from respiratory specimens, including nasal and pharyngeal swabs (NPS), bronchoalveolar lavage fluid (BLF) and sputum.</p></sec><sec id="s0010"><label>2</label><title>Materials and methods</title><sec id="s0015"><label>2.1</label><title>Data collection</title><p id="p0035">4880 cases from Jan 22 to Feb 14 were tested for SARS-CoV-2 infection in Renmin Hospital of Wuhan University, who were suspected or at high risk of infection because of, 1) typical respiratory infection symptoms such as fever, cough and hard breath , or 2) close contact with a SARS-CoV-2 patients. Among these cases, 2251 were man (46.13%), 2629 were women (53.87%). The Median Age was 50 years (IQR=27). Groups based on age: 18-29 (n=482), 30-39 (n=1097), 40-49 (n=841), 50-59 (n=1011), 60-69 (n=886), >70 (n=563). This study was approved by the Ethics Committee of the Renmin Hospital of Wuhan University (WDRM2020-K066) and the need for informed consent was waived.</p></sec></sec><sec id="s0020"><label>3</label><title>RT-PCR Detection</title><p id="p0040">The presence of SARS-CoV-2 in respiratory specimens was detected by real-time RT-PCR amplification of SARS-CoV-2 open reading frame 1ab (ORF1ab), nucleocapsid protein (NP) genes fragments using kits provided by Shanghai Huirui Biotechnology Co.,Ltd. Conditions for amplifications were 50°C for 15 min, 95°C for 3 min, followed by 45 cycles of 95°C for 15 s and 60°C for 30 s. As previously described<xref rid="b0015" ref-type="bibr">[3]</xref>, when two targets (ORF1ab, NP) tested positive by specific real-time RT-PCR, the case would be considered to be laboratory-confirmed. A cycle threshold value (Ct-value) less than 37 was defined as a positive test, and a Ct-value of 40 or more was defined as a negative test. A medium load, defined as a Ct-value of 37 to less than 40, required confirmation by retesting.</p><sec id="s0025"><label>3.1</label><title>Statistical analysis</title><p id="p0045">Statistical analyses were done by using the SPSS25.0 software. Chi-square test was used to compare inter-group differences, and binary logistic regression analysis was performed to analyze the risk factors for SARS-CoV-2 prevalence. Statistical significance was defined as P<0.05.</p></sec></sec><sec id="s0030"><label>4</label><title>Results</title><sec id="s0035"><label>4.1</label><title>Nasal and Pharyngeal Swabs showed poor Positive Rate in 4880 cases</title><p id="p0050">1875 out of 4880 (38.42%) were positive by RT-PCR-based NAT test with their respiratory specimens. Among this, 39.80% were positive for SARS-CoV-2-NP and 40.98% for SARS-CoV-2-ORF1ab (<xref rid="t0005" ref-type="table">Table 1</xref>). We could see that the bronchoalveolar lavage fluid (BLF), exhibited the most highest positive rate of 100% for SARS-CoV-2 ORF1ab gene (n=5). The nasal and pharyngeal swabs (NPS) samples (n=4818) showed a poor positive rate of 38.25%. The Sputum exhibited a 49.12% positive rate.<table-wrap position="float" id="t0005"><label>Table 1</label><caption><p>SARS-CoV-2 NAT positive rate of 4880 cases with their respiratory specimens by RT-PCR</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Nuclear Acid</th><th colspan="2">Sputum(n=57)</th><th colspan="2">Bronchoalveolar Lavage Fluid(n=5)</th><th colspan="2">Nasal and Pharyngeal Swabs(n=4818)</th><th rowspan="2">Total</th><th rowspan="2">Total Positive Rate</th></tr><tr><th>n</th><th>Positive Rate</th><th>n</th><th>Positive Rate</th><th>n</th><th>Positive Rate</th></tr></thead><tbody><tr><td>NP</td><td>28</td><td>49.12%</td><td>4</td><td>80.00%</td><td>1910</td><td>39.64%</td><td>1942</td><td>39.80%</td></tr><tr><td>ORF1ab</td><td>29</td><td>50.88%</td><td>5</td><td>100.00%</td><td>1966</td><td>40.81%</td><td>2000</td><td>40.98%</td></tr><tr><td>Double positive</td><td>28</td><td>49.12%</td><td>4</td><td>80.00%</td><td>1843</td><td>38.25%</td><td>1875</td><td>38.42%</td></tr></tbody></table></table-wrap></p></sec></sec><sec id="s0040"><label>5</label><title>Male had a higher Positive Rate than female in the total 4880 cases</title><p id="p0055">The male patients are 2251, female are 2629. There is no obvious gender difference during sample collection. But for male, 40.43% were positive while for female, 36.71% were positive (<xref rid="t0010" ref-type="table">Table 2</xref>). The Positive Rate were significantly higher in Male than in Female cases (p<0.01).<table-wrap position="float" id="t0010"><label>Table 2</label><caption><p>SARS-CoV-2 NAT positive rate in Male and Female groups</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Nuclear Acid</th><th colspan="2">Male(n=2251)</th><th colspan="2">Female(n=2629)</th><th rowspan="2"><italic>χ<sup>2</sup></italic></th><th rowspan="2">p value</th></tr><tr><th>n</th><th>Positive Rate</th><th>n</th><th>Positive Rate</th></tr></thead><tbody><tr><td>NP</td><td>943</td><td>41.89%</td><td>999</td><td>38.00%</td><td>7.672</td><td>0.006</td></tr><tr><td>ORF1ab</td><td>967</td><td>42.96%</td><td>1033</td><td>39.29%</td><td>6.739</td><td>0.009</td></tr><tr><td>Doublepositive</td><td>910</td><td>40.43%</td><td>965</td><td>36.71%</td><td>7.095</td><td>0.008</td></tr></tbody></table></table-wrap></p></sec><sec id="s0045"><label>6</label><title>The Positive Rate increased in older cases</title><p id="p0060">When we analyzed the positive rate according to age (<xref rid="t0015" ref-type="table">Table 3</xref>), and we could see that positive rate increased from 24.90% (age 18-30) to 61.81% (age >70).<table-wrap position="float" id="t0015"><label>Table 3</label><caption><p>SARS-CoV-2 NAT positive rate in groups according to age</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Nuclear Acid</th><th>18-29</th><th>30-39</th><th>40-49</th><th>50-59</th><th>60-69</th><th>≥70</th><th rowspan="2"><italic>χ<sup>2</sup></italic></th><th rowspan="2">p value</th></tr><tr><th>(n=482)</th><th>(n=1097)</th><th>(n=841)</th><th>(n=1011)</th><th>(n=886)</th><th>(n=563)</th></tr></thead><tbody><tr><td>Gender rate</td><td rowspan="2">229/253</td><td rowspan="2">494/603</td><td rowspan="2">389/452</td><td rowspan="2">451/560</td><td rowspan="2">417/469</td><td rowspan="2">271/292</td><td rowspan="2">3.071</td><td rowspan="2">0.689</td></tr><tr><td>(M/F)</td></tr><tr><td>nCov-NP</td><td>129</td><td>280</td><td>287</td><td>446</td><td>439</td><td>361</td><td>320.802</td><td><0.001</td></tr><tr><td>nCovORF1ab</td><td>124</td><td>286</td><td>296</td><td>461</td><td>466</td><td>367</td><td>353.547</td><td><0.001</td></tr><tr><td>Double Positive</td><td>120</td><td>271</td><td>278</td><td>434</td><td>424</td><td>348</td><td rowspan="2">306.946</td><td rowspan="2"><0.001</td></tr><tr><td>Double Positive Rate</td><td>24.90%</td><td>24.70%</td><td>33.06%</td><td>42.93%</td><td>47.86%</td><td>61.81%</td></tr></tbody></table></table-wrap></p></sec><sec id="s0050"><label>7</label><title>Gender and age are two risk factors for SARS-CoV-2 infection</title><p id="p0065">Binary logistic regression analysis showed that gender and age were two risk factor for SARS-CoV-2 infection (<xref rid="t0020" ref-type="table">Table 4</xref>). Male and older people were more sensitive to the this novel virus infection (p<0.05).<table-wrap position="float" id="t0020"><label>Table 4</label><caption><p>Risks of SARS-CoV-2 positive rate upon Gender and Age</p></caption><table frame="hsides" rules="groups"><thead><tr><th>Risk factors</th><th>Regression coefficient<xref rid="tblfn1" ref-type="table-fn">a</xref></th><th>p value</th><th>odds ratio</th><th>95 % CI forcoefficient</th></tr></thead><tbody><tr><td>Gender</td><td>0.147</td><td>0.016</td><td>1.158</td><td>1.028～1.305</td></tr><tr><td>Age</td><td>0.032</td><td><0.001</td><td>1.033</td><td>1.029～1.037</td></tr></tbody></table><table-wrap-foot><fn id="tblfn1"><label>a</label><p id="np005">These are regression coefficients adjusted for gender and age. CI= confidence interval</p></fn></table-wrap-foot></table-wrap></p></sec><sec id="s0055"><label>8</label><title>Specimens from Fever Clinics exhibited significant higher Positive Rate</title><p id="p0070">Why the positive rate in this 4880 cases were this low? Or did the viral NAT test fail to serve for the diagnosis in this pneumonia epidemic? Since the 4880 specimens conclude all cases during the period in the hospital, such as fever, cough and hard breath, or close contact with COVID-19 patient, we further analyzed data from adult fever clinics (n=1707, <xref rid="t0025" ref-type="table">Table 5</xref>). Notably, the positive rate of patients in fever clinics (57.00%) was significant higher than the rate of the total (38.42%).<table-wrap position="float" id="t0025"><label>Table 5</label><caption><p>SARS-CoV-2 NAT positive rate of 1707 cases from Fever Clinics.</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Nuclear Acid</th><th colspan="2">Sputum(n=14)</th><th colspan="2">Bronchoalveolar Lavage Fluid(n=3)</th><th colspan="2">Nasal and Pharyngeal Swabs(n=1690)</th><th rowspan="2">Total</th><th rowspan="2">Total Positive Rate</th></tr><tr><th>n</th><th>Positive Rate</th><th>n</th><th>Positive Rate</th><th>n</th><th>Positive Rate</th></tr></thead><tbody><tr><td>NP</td><td>11</td><td>78.57%</td><td>2</td><td>66.67%</td><td>980</td><td>57.99%</td><td>993</td><td>58.17%</td></tr><tr><td>ORF1ab</td><td>12</td><td>85.71%</td><td>3</td><td>100.00%</td><td>1031</td><td>61.01%</td><td>1046</td><td>61.28%</td></tr><tr><td>Double positive</td><td>11</td><td>78.57%</td><td>2</td><td>66.67%</td><td>960</td><td>56.80%</td><td>973</td><td>57.00%</td></tr></tbody></table></table-wrap></p></sec><sec id="s0060"><label>9</label><title>The age, not the gender, was the risk factor for SARS-CoV-2 infection in Fever Clinics</title><p id="p0075">When we analyzed the positive rate between Male and Female cases from Fever Clinics, we did not observed significant difference. There were 499 positive male (57.69%) and 474 female (56.29%) from 1707 total Fever Clinics specimens.</p><p id="p0080">When we analyzed data in age-based groups in Fever Clinics, we could see the older had higher positive rate (<xref rid="t0030" ref-type="table">Table 6</xref>). Positive rate in each group were 38.83%, 48.96%, 53.77%, 56.88%, 57.33% and 76.69%, which were significantly higher than the rate in the total 4880 cases.<xref rid="t0035" ref-type="table">Table 7.</xref><table-wrap position="float" id="t0030"><label>Table 6</label><caption><p>SARS-CoV-2 NAT positive rate in Fever Clinics grouped according to age.</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Nuclear Acid</th><th>18-29</th><th>30-39</th><th>40-49</th><th>50-59</th><th>60-69</th><th>≥70</th><th rowspan="2"><italic>χ<sup>2</sup></italic></th><th rowspan="2">p value</th></tr><tr><th>(n=103)</th><th>(n=241)</th><th>(n=292)</th><th>(n=385)</th><th>(n=450)</th><th>(n=236)</th></tr></thead><tbody><tr><td>Gender rate</td><td rowspan="2">58/45</td><td rowspan="2">126/115</td><td rowspan="2">152/140</td><td rowspan="2">185/200</td><td rowspan="2">224/226</td><td rowspan="2">120/116</td><td rowspan="2">2.988</td><td rowspan="2">0.702</td></tr><tr><td>(M/F)</td></tr><tr><td>nCov-NP</td><td>41</td><td>119</td><td>161</td><td>222</td><td>264</td><td>186</td><td>64.456</td><td><0.001</td></tr><tr><td>nCovORF1ab</td><td>41</td><td>127</td><td>168</td><td>234</td><td>289</td><td>187</td><td>62.98</td><td><0.001</td></tr><tr><td>Double Positive</td><td>40</td><td>118</td><td>157</td><td>219</td><td>258</td><td>181</td><td rowspan="2">58.835</td><td rowspan="2"><0.001</td></tr><tr><td>Double Positive Rate</td><td>38.83%</td><td>48.96%</td><td>53.77%</td><td>56.88%</td><td>57.33%</td><td>76.69%</td></tr></tbody></table></table-wrap><table-wrap position="float" id="t0035"><label>Table 7</label><caption><p>SARS-CoV-2 NAT positive rate in Fever Clinics in different date periods</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2">Nuclear Acid</th><th colspan="2">22<sup>th</sup> -29<sup>th</sup> Jan(n=286)</th><th colspan="2">30<sup>th</sup> Jan-6<sup>th</sup> Feb(n=988)</th><th colspan="2">7<sup>th</sup> - 14<sup>th</sup> Feb(n=433)</th><th rowspan="2"><italic>χ<sup>2</sup></italic></th><th rowspan="2">p value</th></tr><tr><th>n</th><th>Positive Rate</th><th>n</th><th>Positive Rate</th><th>n</th><th>Positive Rate</th></tr></thead><tbody><tr><td>NP</td><td>152</td><td>53.15%</td><td>648</td><td>65.59%</td><td>193</td><td>44.57%</td><td>58.205</td><td><0.001</td></tr><tr><td>ORF1ab</td><td>169</td><td>59.09%</td><td>668</td><td>67.61%</td><td>209</td><td>48.27%</td><td>48.166</td><td><0.001</td></tr><tr><td>Double positive</td><td>152</td><td>53.15%</td><td>631</td><td>63.87%</td><td>190</td><td>43.88%</td><td>51.148</td><td><0.001</td></tr></tbody></table></table-wrap></p><p id="p0085">Binary logistic regression analysis showed that the age, not the gender, was the risk factor for SARS-CoV-2 infection in Fever Clinics.</p><p id="p0090">There was a quite special period that a large amount of patients rushed to health care centres or fever clinics because of panic in early Feb in Wuhan City, when a bigger amount of patients far beyond the capacity of laboratory testing. We analyzed positive percentage for SARS-CoV-2 infection in each week during 22th Jan to 14<sup>th</sup> Feb from Fever Clinics in Renmin Hospital. 63.87% (631 out of 988) were double positive for viral genes testing, which indicated a real high number of SARS-CoV-2 infection among this panic suspect population.</p></sec><sec id="s0065"><label>10</label><title>Discussion</title><p id="p0095">For the 2019 novel coronavirus disease (COVID-19), patients can be afebrile in the early stages of infection, with only chills and respiratory symptoms, but not always high temperature<xref rid="b0020" ref-type="bibr">[4]</xref>, <xref rid="b0025" ref-type="bibr">[5]</xref>, <xref rid="b0030" ref-type="bibr">[6]</xref>. Elevated C-reactive protein (CRP) and lymphopenia are important factors. More and more evidence had shown distinct and complicated performance of COVID-19 as compared to SARS or MERS, which provided typical clinical symptoms for diagnosis<xref rid="b0025" ref-type="bibr">[5]</xref>. Therefore, diagnosis of suspected SARS-CoV-2 caused pneumonia in Wuhan was based on clinical characteristics, chest imaging<xref rid="b0005" ref-type="bibr">[1]</xref>, <xref rid="b0035" ref-type="bibr">[7]</xref>, and the ruling out of common bacterial and viral pathogens that cause pneumonia as suggested by the latest National recommendations for diagnosis and treatment of pneumonia caused by 2019-nCoV (the 6th edition).</p><p id="p0100">Here in this study, we analyzed recent 4880 cases by laboratory diagnosis of suspect SARS-CoV-2 infection in one hospital in Wuhan City, showing 38.42% positive percentage for total, but 57.00% positive in Fever Clinics. Relatively increased positive percentage in Fever Clinics suggested that the fever associated clinical symptoms were linked with viral NAT, at some degree. Interestingly, total positive percentage were associated with gender and age, while positive percentage in Fever Clinics was only associated with age, not gender. Therefore, consistent with other reports, we could conclude that for suspect SARS-CoV-2 infection, positive percentage would be higher in Male and Old, but in Fever Clinics, gender was not a risk factor.</p><p id="p0105">The epidemic seems to be spreading rapidly worldwide, especially in Korea, Italy and Iran. Based on the reasons mentioned above, we suggest that viral NAT is a rapid, easy conducted, and widely used laboratory diagnosis for SARS-CoV-2 infection, especially for Fever Clinics. Clinical characteristics, chest imaging and etiology testing based on viral genes RT-PCR should be combined to tell a confirmation<xref rid="b0020" ref-type="bibr">[4]</xref>, <xref rid="b0040" ref-type="bibr">[8]</xref>. Since there exists infection with atypical symptoms, RT-PCR should be taken for several times just in case of fake negative results.</p><p id="p0110">For those countries who are facing an increased number of SARS-CoV-2 infection, we strongly suggest to prepare more reagents for SARS-CoV-2 NAT. Also, more laboratories and facilities should be trained and prepared for RT-PCR detection under a Biological Safety Protection 3-Level, just in case the horrible increasing requirements for detection that happened in early Feb in Wuhan, China.</p></sec></body><back><ref-list id="bi005"><title>References</title><ref id="b0005"><label>1</label><element-citation publication-type="journal" id="h0005"><person-group person-group-type="author"><name><surname>Fang</surname><given-names>Y.</given-names></name><name><surname>Zhang</surname><given-names>H.</given-names></name><name><surname>Xie</surname><given-names>J.</given-names></name></person-group><article-title>Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR</article-title><source>Radiology</source><volume>200432</volume><year>2020</year></element-citation></ref><ref id="b0010"><label>2</label><element-citation publication-type="journal" id="h0010"><person-group person-group-type="author"><name><surname>Xie</surname><given-names>X.</given-names></name><name><surname>Zhong</surname><given-names>Z.</given-names></name><name><surname>Zhao</surname><given-names>W.</given-names></name><name><surname>Zheng</surname><given-names>C.</given-names></name><name><surname>Wang</surname><given-names>F.</given-names></name><name><surname>Liu</surname><given-names>J.</given-names></name></person-group><article-title>Chest CT for Typical 2019-nCoV Pneumonia: Relationship to Negative RT-PCR Testing</article-title><source>Radiology</source><volume>200343</volume><year>2020</year></element-citation></ref><ref id="b0015"><label>3</label><element-citation publication-type="journal" id="h0015"><person-group person-group-type="author"><name><surname>Li</surname><given-names>Q.</given-names></name><name><surname>Guan</surname><given-names>X.</given-names></name><name><surname>Wu</surname><given-names>P.</given-names></name></person-group><article-title>Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia</article-title><source>The New England journal of medicine</source><year>2020</year></element-citation></ref><ref id="b0020"><label>4</label><element-citation publication-type="journal" id="h0020"><person-group person-group-type="author"><name><surname>Huang</surname><given-names>C.</given-names></name><name><surname>Wang</surname><given-names>Y.</given-names></name><name><surname>Li</surname><given-names>X.</given-names></name></person-group><article-title>Clinical features of patients infected with 2019 novel coronavirus in Wuhan</article-title><source>China. 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Time Course of Lung Changes On Chest CT During Recovery From 2019 Novel Coronavirus (COVID-19) Pneumonia. Radiology 2020:200370.</mixed-citation></ref><ref id="b0040"><label>8</label><element-citation publication-type="journal" id="h0040"><person-group person-group-type="author"><name><surname>Chen</surname><given-names>N.</given-names></name><name><surname>Zhou</surname><given-names>M.</given-names></name><name><surname>Dong</surname><given-names>X.</given-names></name></person-group><article-title>Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study</article-title><source>Lancet</source><volume>395</volume><year>2020</year><fpage>507</fpage><lpage>513</lpage><pub-id pub-id-type="pmid">32007143</pub-id></element-citation></ref></ref-list><ack id="ak005"><sec id="s0070"><title>Acknowledgement</title><p id="p0115">This work was supported by the National Mega Project on Major Infectious Disease Prevention under Grant 2017ZX10103005, the National Natural Science Foundation of China (81672079) to C.L.Z. and the National Natural Science Foundation of China (81471940) to Y.F.</p></sec><sec id="s0075"><title>Author contributions</title><p id="p0120">Y.F and C.L.Z designed the study and analyzed the data. R.L and H.H collected and analyzed the data. F.L., Z.H.L., Y.L.L., and K.L.W wrote the paper. Y.F and C.L.Z read and approved the final manuscript.</p></sec></ack></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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