The value of point-of-care tests for the detection of SARS-CoV-2 RNA or antigen in bronchoalveolar lavage fluid

Jan Van Slambrouck; Charlotte Schoenaers; Lies Laenen; Xin Jin; Kurt Beuselinck; Ann Verdonck; Joost Wauters; Geert Molenberghs; Bart M Vanaudenaerde; Robin Vos; Peter Mombaerts; Katrien Lagrou; Laurens J Ceulemans

doi:10.1016/j.jviromet.2023.114848

The value of point-of-care tests for the detection of SARS-CoV-2 RNA or antigen in bronchoalveolar lavage fluid

J Virol Methods. 2024 Jan:323:114848. doi: 10.1016/j.jviromet.2023.114848. Epub 2023 Nov 7.

Authors

Affiliations

¹ Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
² Department of Laboratory Medicine & National Reference Center for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium.
³ Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium.
⁴ Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium.
⁵ Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven and UHasselt, Leuven, Belgium.
⁶ Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
⁷ Max Planck Research Unit for Neurogenetics, Frankfurt, Germany.
⁸ Department of Laboratory Medicine & National Reference Center for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, KU Leuven, Leuven, Belgium.
⁹ Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium. Electronic address: laurens.ceulemans@uzleuven.be.

PMID: 37944670
DOI: 10.1016/j.jviromet.2023.114848

Abstract

Background: Transmission of SARS-CoV-2 from donor to recipient is a clinically relevant risk for developing severe COVID-19 after lung transplantation (LTx). This risk of iatrogenic transmission can be reduced by timely detection of viral RNA or antigen in samples of bronchoalveolar lavage (BAL) fluid obtained at the time of lung procurement. We aimed to retrospectively evaluate the detection of SARS-CoV-2 RNA or antigen in BAL fluid samples using three point-of-care tests (POCTs).

Methods: BAL fluid samples came from patients hospitalized in an intensive care unit during the COVID-19 pandemic. These pandemic samples were scored as positive or negative for SARS-CoV-2 by a RT-qPCR comparator assay for orf1ab. Three commercially available POCTs were then evaluated: cobas SARS-CoV-2 & Influenza A/B assay with the cobas Liat RT-qPCR system (Roche Diagnostics), ID NOW COVID-19 and COVID-19 2.0 (Abbott), and SARS-CoV-2 Rapid Antigen Test (RAT) (Roche Diagnostics). Samples from the pre-pandemic era served as negative controls.

Results: We analyzed a total of 98 BAL fluid samples, each from a different patient: 58 positive pandemic samples (orf1ab Ct<38), 20 putatively negative pandemic samples (orf1ab Ct≥38), and 20 pre-pandemic samples. Univariate logistic regression shows that the probability of detection was highest for cobas Liat, followed by ID NOW, and then RAT. Of clinical relevance, cobas Liat detected SARS-CoV-2 RNA in 30 of the 31 positive pandemic samples that were collected within 10 days after RT-qPCR diagnosis of SARS-CoV-2 infection. None of the 20 pre-pandemic samples had a false-positive result for any POCT.

Conclusions: POCTs enable the detection of SARS-CoV-2 RNA or antigen in BAL fluid samples and may provide additional information to decide if donor lungs are suitable for transplantation. Detection of respiratory pathogens with POCTs at the time of donor lung procurement is a potential strategy to increase safety in LTx by preventing iatrogenic transmission and severe postoperative infections.

Keywords: Bronchoalveolar lavage; COVID-19; Lung transplantation; Point-of-care test; SARS-CoV-2.

MeSH terms

Antigens, Viral / analysis
Bronchoalveolar Lavage Fluid
COVID-19* / diagnosis
Humans
Iatrogenic Disease
Pandemics
Point-of-Care Testing
RNA, Viral / genetics
Retrospective Studies
SARS-CoV-2 / genetics
Sensitivity and Specificity

Substances

RNA, Viral
Antigens, Viral