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Sensitivity and specificity of 14 SARS-CoV-2 serological assays and their diagnostic potential in RT-PCR negative COVID-19 infections

Eveline Van Honacker, Liselotte Coorevits, Jerina Boelens (UGent) , Bruno Verhasselt (UGent) , Eva Van Braeckel (UGent) , Fre Bauters (UGent) , Liesbet De Bus (UGent) , Petra Schelstraete (UGent) , Jef Willems (UGent) , Stien Vandendriessche (UGent) , et al.
(2022) ACTA CLINICA BELGICA. 77(2). p.315-320
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Abstract
Background: Molecular detection of SARS-CoV-2 in respiratory samples is the gold standard for COVID-19 diagnosis but it has a long turnaround time and struggles to detect low viral loads. Serology could help to diagnose suspected cases which lack molecular confirmation. Two case reports are presented as illustration. Objectives: The aim of this study was to evaluate the performance of several commercial assays for COVID-19 serology. We illustrated the added value of COVID-19 serology testing in suspect COVID-19 cases with negative molecular test. Study design: Twenty-three sera from 7 patients with a confirmed molecular diagnosis of SARS-CoV-2 were tested using 14 commercial assays. Additionally, 10 pre-pandemic sera and 9 potentially cross-reactive sera were selected. We calculated sensitivity and specificity. Furthermore, we discuss the diagnostic relevance of COVID-19 serology in a retrospective cohort of 145 COVID-19 cases in which repetitive molecular and serological SARS-CoV-2 tests were applied. Results: The interpretation of the pooled sensitivity of IgM/A and IgG resulted in the highest values (range 14-71% on day 2-7; 88-94% on day 8-18). Overall, the specificity of the assays was high (range 79-100%). Among 145 retrospective cases, 3 cases (2%) remained negative after sequential molecular testing but positive on final SARS-CoV-2 serology. Conclusion: Sensitivity of COVID-19 serological diagnosis was variable but consistently increased at >7 days after symptom onset. Specificity was high. Our data suggest that serology can complement molecular testing for diagnosis of COVID-19, especially for patients presenting the 2(nd) week after symptom onset or later.
Keywords
SARS-CoV-2, serology, performance, diagnosis, COVID-19

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MLA
Van Honacker, Eveline, et al. “Sensitivity and Specificity of 14 SARS-CoV-2 Serological Assays and Their Diagnostic Potential in RT-PCR Negative COVID-19 Infections.” ACTA CLINICA BELGICA, vol. 77, no. 2, 2022, pp. 315–20, doi:10.1080/17843286.2020.1861885.
APA
Van Honacker, E., Coorevits, L., Boelens, J., Verhasselt, B., Van Braeckel, E., Bauters, F., … Padalko, E. (2022). Sensitivity and specificity of 14 SARS-CoV-2 serological assays and their diagnostic potential in RT-PCR negative COVID-19 infections. ACTA CLINICA BELGICA, 77(2), 315–320. https://doi.org/10.1080/17843286.2020.1861885
Chicago author-date
Van Honacker, Eveline, Liselotte Coorevits, Jerina Boelens, Bruno Verhasselt, Eva Van Braeckel, Fre Bauters, Liesbet De Bus, et al. 2022. “Sensitivity and Specificity of 14 SARS-CoV-2 Serological Assays and Their Diagnostic Potential in RT-PCR Negative COVID-19 Infections.” ACTA CLINICA BELGICA 77 (2): 315–20. https://doi.org/10.1080/17843286.2020.1861885.
Chicago author-date (all authors)
Van Honacker, Eveline, Liselotte Coorevits, Jerina Boelens, Bruno Verhasselt, Eva Van Braeckel, Fre Bauters, Liesbet De Bus, Petra Schelstraete, Jef Willems, Stien Vandendriessche, and Elizaveta Padalko. 2022. “Sensitivity and Specificity of 14 SARS-CoV-2 Serological Assays and Their Diagnostic Potential in RT-PCR Negative COVID-19 Infections.” ACTA CLINICA BELGICA 77 (2): 315–320. doi:10.1080/17843286.2020.1861885.
Vancouver
1.
Van Honacker E, Coorevits L, Boelens J, Verhasselt B, Van Braeckel E, Bauters F, et al. Sensitivity and specificity of 14 SARS-CoV-2 serological assays and their diagnostic potential in RT-PCR negative COVID-19 infections. ACTA CLINICA BELGICA. 2022;77(2):315–20.
IEEE
[1]
E. Van Honacker et al., “Sensitivity and specificity of 14 SARS-CoV-2 serological assays and their diagnostic potential in RT-PCR negative COVID-19 infections,” ACTA CLINICA BELGICA, vol. 77, no. 2, pp. 315–320, 2022.
@article{8688253,
  abstract     = {{Background: Molecular detection of SARS-CoV-2 in respiratory samples is the gold standard for COVID-19 diagnosis but it has a long turnaround time and struggles to detect low viral loads. Serology could help to diagnose suspected cases which lack molecular confirmation. Two case reports are presented as illustration.
Objectives: The aim of this study was to evaluate the performance of several commercial assays for COVID-19 serology. We illustrated the added value of COVID-19 serology testing in suspect COVID-19 cases with negative molecular test.
Study design: Twenty-three sera from 7 patients with a confirmed molecular diagnosis of SARS-CoV-2 were tested using 14 commercial assays. Additionally, 10 pre-pandemic sera and 9 potentially cross-reactive sera were selected. We calculated sensitivity and specificity. Furthermore, we discuss the diagnostic relevance of COVID-19 serology in a retrospective cohort of 145 COVID-19 cases in which repetitive molecular and serological SARS-CoV-2 tests were applied.
Results: The interpretation of the pooled sensitivity of IgM/A and IgG resulted in the highest values (range 14-71% on day 2-7; 88-94% on day 8-18). Overall, the specificity of the assays was high (range 79-100%). Among 145 retrospective cases, 3 cases (2%) remained negative after sequential molecular testing but positive on final SARS-CoV-2 serology.
Conclusion: Sensitivity of COVID-19 serological diagnosis was variable but consistently increased at >7 days after symptom onset. Specificity was high. Our data suggest that serology can complement molecular testing for diagnosis of COVID-19, especially for patients presenting the 2(nd) week after symptom onset or later.}},
  author       = {{Van Honacker, Eveline and Coorevits, Liselotte and Boelens, Jerina and Verhasselt, Bruno and Van Braeckel, Eva and Bauters, Fre and De Bus, Liesbet and Schelstraete, Petra and Willems, Jef and Vandendriessche, Stien and Padalko, Elizaveta}},
  issn         = {{1784-3286}},
  journal      = {{ACTA CLINICA BELGICA}},
  keywords     = {{SARS-CoV-2,serology,performance,diagnosis,COVID-19}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{315--320}},
  title        = {{Sensitivity and specificity of 14 SARS-CoV-2 serological assays and their diagnostic potential in RT-PCR negative COVID-19 infections}},
  url          = {{http://doi.org/10.1080/17843286.2020.1861885}},
  volume       = {{77}},
  year         = {{2022}},
}
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