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2021, vol. 2, br. 3, str. 302-305
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Ograničenja primene brzih seroloških testova na SARS-KoV-2 kod nevakcinisanih pacijenata u urgentnim kardioškim stanjima
Limitations of rapid serological testing for SARS-CoV-2 in non-vaccinated patients in acute cardiac care
aKlinički centar Srbije, Klinika za kardiologiju, Beograd, Srbija bKlinički centar Srbije, Klinika za kardiologiju, Beograd, Srbija + Univerzitet u Beogradu, Medicinski fakultet, Srbija
e-adresa: maki.marijapolovina@gmail.com
Sažetak
U decembru 2019. godine, u gradu Vuhanu, u Kini, registrovani su prvi slučajevi infekcije izazvane novim SARS-KoV-2 virusom. U daljem toku je bolest izazvana ovim virusom nazvana KOVID-19. Ubrzo nakon toga, 11. marta 2020. godine, Svetska zdravstvena organizacija proglasila je pandemiju KOVID-19 infekcije. KOVID-19 i akutna kardiološka stanja (npr. srčana insuficijencija, embolija pluća ili ishemija miokarda) često imaju sličnu kliničku prezentaciju, što predstavlja izazov u postavljanju adekvatne dijagnoze u kliničkoj praksi. Osnovna namena brzih seroloških testova za detekciju IgM i IgG antitela na SARS-KoV-2 je procena imunološkog odgovora na ovaj virus. Međutim, brzi serološki testovi se često upotrebljavaju van okvira osnovne namene, za trijažu potencijalno inficiranih, nevakcinisanih pacijenata, zbog brzog dobijanja rezultata, što je naročito važno u urgentnim stanjima. Ukoliko se serološko testiranje koristi za trijažu nevakcinisanih pacijenata, u smislu prijema u izolacionu jedinicu za suspektne KOVID-19 pozitivne bolesnike ili na odeljenja gde su smešteni KOVID-19 negativni bolesnici, potrebno je poznavati njihova ograničenja da bi se redukovao rizik lažno pozitivnih i lažno negativnih rezultata. Neophodna je adekvatna selekcija pacijenata i obazriva interpretacija rezultata kako bi se izbegla pogrešna dijagnoza. Cilj ovog rada je da opiše kako se serološki testovi mogu upotrebiti za trijažu kardioloških pacijenata, navakcinisanih protiv SARS-KoV-2 virusa, koji zahtevaju urgentnu hospitalizaciju. Radi ilustracije, prikazujemo dva bolesnika kod kojih je primena ovih testova dala svrsishodne rezultate.
Abstract
In December 2019 in the city of Wuhan, in China, the first cases of infection caused by the new SARS-CoV-2 virus appeared, and later on, the disease caused by this virus was named COVID-19. Shortly after this, on March 11 th , 2020, the WHO characterized COVID-19 as a global pandemic. The symptoms of COVID-19 and acute cardiovascular disorders (e.g., heart failure, pulmonary embolism or myocardial ischemia) frequently overlap, which poses a challenge for the establishing of a differential diagnosis in clinical practice. Rapid serological tests, which detect IgM and IgG classes of antibodies for SARS-CoV 2, have been developed with the primary purpose of screening the population's immunological response to the SARS-CoV-2 virus. However, rapid serological tests are often used outside their original purpose, i.e., for the triage of possibly infected, non-vaccinated individuals, because they offer quick results, which may be particularly relevant in emergency settings. If serological testing is used to guide the admission of non-vaccinated patients with acute cardiovascular disorders to either an isolation unit for suspected COVID-19 positive individuals, or to hospital facilities for non-infected patients, it is important to recognize its limitations, in order to reduce the risk of false-positive or false-negative results. Hence, appropriate patient selection and cautious test interpretation is necessary to avoid misdiagnosis. The aim of this paper is to illustrate how serological testing may be used as a screening tool to inform the management of non-vaccinated patients with acute cardiovascular disorders requiring urgent hospital admission. As an illustration, we describe two clinical situations, in which serological testing produced meaningful results.
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