Tesis

Uji Diagnostik RT-PCR Faecal pada COVID-19 = The value of faecal RT-PCR test for SARS CoV-2 infection during COVID-19 pandemic.

Latar Belakang : Pasien yang terinfeksi COVID-19 sering menunjukkan gejala pencernaan seperti diare, mual, dan sakit perut. Dalam beberapa penelitian telah menemukan RNA SARS CoV-2 dalam spesimen faecal pasien yang terinfeksi. Tujuan : Mengetahui nilai RT-PCR faecal dan membandingkannya dengan RTPCR naso-orofaring sebagai standar emas pada pasien COVID-19. Metode : Penelitian ini adalah studi deskriptif observasional, mendeteksi partikel virus melalui pemeriksaan RT-PCR pada faecal pasien COVID-19 yang dirawat di rumah sakit. Penelitian dilakukan di Rumah Sakit Nasional Dr. Cipto Mangunkusumo, Rumah Sakit Mitra Keluarga Depok, Rumah Sakit Mitra Keluarga Kelapa Gading, dan Rumah Sakit Ciputra, Indonesia. Swab naso-oro-orofaringeal dan spesimen feses dikumpulkan untuk deteksi RNA SARS CoV-2 Hasil : Dari 142 subjek ada 44 subjek yang diekslusi, karena 12 sampel tidak dapat diekstraksi (kering) dan 32 subjek yang mengalami kesulitan buang air besar. Jadi diperoleh 98 sampel. Tingkat keparahan dalam penelitian kami adalah 84,7% sebagai kasus ringan hingga sedang dan 15,3% dalam kondisi kritis dengan 12,2% memiliki sindrom gangguan pernapasan akut. Dalam penelitian ini memiliki nilai sensitifitas yang rendah (38,10%) juga nilai NPV (20,00%). Namun memiliki spesifisitas tinggi (92,86%) juga nilai PPV (96,97%). Sebagai tambahan, kami menganalisa sujects dengan gejala saluran cerna, namun memiliki hasil yang serupa (n = 68, 69,39%, sensitifitas 38,60%, spesifisitas 90,91%).. Kesimpulan : Tingginya spesifisitas dan PPV dalam penelitian ini menunjukkan bahwa hasil positif pada pemeriksaan RT-PCR faecal sangat baik digunakan untuk membantu menegakkan diagnosis COVID-19. Namun, sensitifitas dan NPV yang rendah menunjukkan bahwa hasil negatif tidak dapat digunakan untuk menyingkirkan COVID-19. Oleh karena itu, pemeriksaan RT-PCR faecal merupakan tes yang sangat baik sebagai tes konfirmasi COVID-19. RT-PCR faecal kurang tepat jika digunakan sebagai tes pada awal masuk pasien COVID-19 (screening), RT-PCR swab naso-orofaring masih lebih baik digunakan sebagai standar diagnostik (screening) untuk COVID-19.
Kata kunci : COVID-19, RT-PCR faecal , RT-PCR naso-orofaring, sensitifitas, spesifisitas, NDP, NDN


Background: Patients infected by COVID-19 also show gastrointestinal symptoms like diarrhea, nausea, and abdominal pain. In some studies have found SARS CoV2 RNA in faecal specimens of infected patients. Aims: This study will test the performance of faecal reserve transcription polymerase chain reaction (RT-PCR) when compared with naso-oropharyngeal swab RT-PCR as the gold standard test in COVID-19. Materials and Methods: This is an observational descriptive study by detection viral particle by RT-PCR on faecal from patients which suspected or probable cases of hospitalized COVID-19 infection, conducted in Dr. Cipto Mangunkusumo National Hospital, Mitra Keluarga Depok Hospital, Mitra Keluarga Kelapa Gading Hospital, and Ciputra Hospital, Indonesia. Naso-oropharyngeal swab and faecal spesimens were collected for RNA SARS CoV-2 detection. Results: We found 142 subjects, but there were 44 subjects that were not included, as faecal samples could not be extracted (dried) by 12 samples and subjects that had difficulty defecating as many as 32 subjects. So we analized 98 subjects. The severity spectrum of COVID-19 manifestation in our study was 84,7 % classified as mild to medium cases and 15,3% in critical condition with 12,2% had acute respiratory distress syndrome. We compared faecal specimen with Nasooropharyngeal swab RT-PCR, the sensitivity and specificity of faecal were 38,10% and 92,86%. The positive and negatif predictive value were 96,97% and 20,00%. When we analize the sujects with gastrointestinal simtoms, the performance of faecal remained similar ( n=68, 69,39%, sensitivity 38,60%, specivicity 90,91%). Conclusion: Faecal specimen has low sensitivity value (38.10%) and NPV (20.00%). However, it has a high specificity (92.86%) and PPV (96.97%). The high specificity and PPV in this study showed that the positive results on the RT-PCR examination of faecal were very well used to help enforce the diagnosis of COVID19. However, low sensitivity and NPV indicate that negative results cannot be used to exlude COVID-19. Therefore, faecal RT-PCR examination is an excellent test as a confirmation test of COVID-19, but faecal RT-PCR may not be used as an additional test at beginning of diagnostik COVID-19 patients, naso-oropharyngeal swab RT-PCR still used as the standard diagnostik for COVID-19.
Keywords: COVID-19, faecal RT-PCR , naso-oropharynx RT-PCR ,sensitivity, specificity, PPV, NPV