scholarly journals High mortality with High false negative rate: COVID-19 infection in patients with hematologic malignancies

2021 ◽  
Vol 106 ◽  
pp. 106582
Author(s):  
Alex Niu ◽  
Bo Ning ◽  
Francisco Socola ◽  
Hana Safah ◽  
Tim Reynolds ◽  
...  
Keyword(s):  
High Mortality ◽  
False Negative ◽  
False Negative Rate ◽  
Hematologic Malignancies ◽  
Negative Rate ◽  
High False Negative Rate

scholarly journals COVID-19 in Patients with Hematological Malignancies: High False Negative Rate with High Mortality

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 6-7
Author(s):  
Alex Niu ◽  
Bo Ning ◽  
Francisco Socola ◽  
Hana Safah ◽  
Tim Reynolds ◽  
...  
Keyword(s):  
High Mortality ◽  
Hematological Malignancies ◽  
False Negative ◽  
False Negative Rate ◽  
Respiratory Illness ◽  
Advisory Board ◽  
Rt Pcr ◽  
Negative Rate ◽  
Asymptomatic Patients ◽  
High False Negative Rate

Introduction Patients with hematological malignancies (HM) are uniquely immunocompromised and considered at high risk for COVID-19. However, data regarding the diagnosis, clinical course, treatment, and outcomes of these patients is sparse. In particular, the ability to successfully detect SARS-CoV-2 in patients with HM remains unknown. We have previously reported 2 cases of allogeneic stem cell transplant (SCT) diagnosed with COVID-19 using clustered regularly interspaced short palindromic repeats (CRISPR) technique, following multiple negative nasopharyngeal RT-PCR testing (Niu et al. Bone Marrow Transplantation - Nature). Here we examine 29 patients with a variety of HM with high suspicion for COVID-19 based on clinical presentation, lab results, and imaging, whom were tested with CRISPR and/or RT-PCR based techniques. From 3/31/20 to 7/17/20, 29 patients (age 24 to 82) with a variety of HM (20 lymphoid, 9 myeloid; Table 1), 24 of which presented with an undiagnosed respiratory illness and 5 presented while asymptomatic for testing prior to chemotherapy, were evaluated for COVID-19. While 16 patients tested positive for COVID-19 with guideline-directed nasopharyngeal RT-PCR testing (including the 5 asymptomatic patients), 13 patients tested negative with the same technique. However, based on their clinical history, imaging, and disease course, concern for COVID-19 infection remained in these 13 patients. We then used CRISPR technology available at our institution (Huang et al. Biosensors and Bioelectronics) to test 8 patients who initially tested negative by RT-PCR. Surprisingly, 7 of the 8 patients tested positive for COVID-19 with either a blood sample and/or nasal swab for the SARS-CoV-2 specific N gene and ORF1ab gene. Excluding the patients who were negative by RT-PCR and not tested by CRISPR, the rate of false negativity with RT-PCR testing is significantly elevated at 29% (7/24) in our cohort of HM, which compares unfavorably with the expected false negative rates of RT-PCR techniques. A very high fatality rate was observed with 9 out of the 29 patients (31%) ultimately dying. Fifteen patients were undergoing active chemotherapy, 4 had received an autologous SCT, 6 had received an allogeneic SCT, and 4 were on surveillance. Of the 23 COVID-19 positive patients (by RT-PCR or CRISPR), 8 patients received COVID-19-directed therapy with either hydroxychloroquine/azithromycin, remdesivir, and/or Covid-19 convalescent plasma (CCP) depending on their clinical status, and 4 patients expired. Of the 8 treated patients, 7 improved while 1 patient expired. For the 5 patients who were negative for RT-PCR with no CRISPR completed, 1 patient received hydroxychloroquine/azithromycin proactively due to symptoms and imaging and recovered, while 3 patients expired at outside facilities due to unknown causes. Breakdown of testing and treatment is shown in Fig. 1. The majority of our patients had undergone SCT or were actively on chemotherapy, notably lymphodepleting chemotherapy. Associated with the fact that COVID-19 is known to worsen lymphopenia, our patient's symptoms and immune response to COVID-19 is likely to differ from immunocompetent hosts. This translated into an overall worse outcome as seen by the high mortality with our patients. In our limited dataset, patients presented with a variety of symptoms ranging from asymptomatic to acute respiratory failure. Intriguingly, the 5 asymptomatic patients had lymphoid malignancies and were on chemotherapy. It is thus imperative to establish the diagnosis of COVID-19 quickly, as faster initiation of treatment has been associated with better outcomes. The 8 patients who were diagnosed and treated improved substantially. However, as seen by our dataset, a strikingly high false negative rate was observed. Thus, a high clinical suspicion must guide further workup and therapy in patients with HM who present with an undiagnosed respiratory illness consistent with COVID-19. Patients with HM can have a wide variety of presentations when infected with COVID-19. For this select patient population we must establish an algorithm to diagnose COVID-19 efficiently as we reported a high number of initial false negative COVID-19 tests before the more sensitive CRISPR revealed a positive test. In addition, treatment pathways need to be instituted to not only treat COVID-19 infection, but also provide the best treatment for these patient's underlying HM. Disclosures Safah: Amgen: Honoraria; Verastem: Honoraria; Janssen: Speakers Bureau; Astellas: Speakers Bureau. Saba:Kite: Other: Advisory Board; Pharmacyclics: Other: Advisory Board, Speakers Bureau; AbbVie: Consultancy, Other: Advisory Board, Speakers Bureau; Janssen: Other: Advisory Board, Speakers Bureau; Kyowa Kirin: Other: Advisory Board.

scholarly journals 0587 Convenience vs Accuracy: Negative Predictability of the Home Sleep Test in Clinical Practice

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A225-A225
Author(s):  
C D Morse ◽  
S Meissner ◽  
L Kodali
Keyword(s):  
Clinical Practice ◽  
Sleep Apnea ◽  
False Negative ◽  
False Negative Rate ◽  
True Negative ◽  
Negative Rate ◽  
High False Negative Rate ◽  
Obstructive Sleep ◽  
Respiratory Disturbance ◽  
Lost To Follow Up

Abstract Introduction Sleep apnea is a serious disorder associated with numerous health conditions. In clinical practice, providers order screening home sleep testing (HST) for obstructive sleep apnea (OSA); however, there is limited research about the negative predictive value (NPV) and false negative rate of this test. Providers may not understand HST limitations; therefore, what is the NPV and false negative rate in clinical practice? Methods A retrospective study of non-diagnostic HST is conducted in a Northeastern US rural community sleep clinic. The study population includes adult patients ≥ 18 years old who underwent HST from 2016-2019. The non-diagnostic HST result is compared to the gold standard, the patient’s nocturnal polysomnogram (NPSG). The results provide the NPV (true negative/total) and false negative (true positive/total) for the non-diagnostic HST. Results We identified 211 potential patients with a mean age of 43 years, of which 67% were female. Of those, 85% (n=179) underwent NPSG, with the others declining/delaying testing or lost to follow up. The non-diagnostic HST showed 15.6% NPV for no apnea using AHI<5 and 8.4% NPV using respiratory disturbance index (tRDI)<5. The false negative rate for AHI/tRDI was 84.4% and 91.6%, respectively. The AHI for positive tests ranged from 5-89 per hour (mean AHI 14.9/tRDI 16/hour), of which OSA was identified with an elevated AHI (≥5) ranging from 54.2% mild, 21.8% moderate, and 8.4% severe. Conclusion The high false negative rate of the HST is alarming. Some providers and patients may forgo NPSG after non-diagnostic HST due to a lack of understanding for the HST’s limitations. Knowing that the non-diagnostic HST is a very poor predictor of no sleep apnea will help providers advise patients appropriately for the necessity of the NPSG. The subsequent NPSG provides an accurate diagnosis and, therefore, an informed decision about pursuing or eschewing sleep apnea treatment. Support none

scholarly journals A False Negative Study of the Steganalysis Tool Stegdetect

2020 ◽  
Vol 10 (22) ◽  
pp. 8188
Author(s):  
Benjamin Aziz ◽  
Jeyong Jung ◽  
Julak Lee ◽  
Yong-Tae Chun
Keyword(s):  
Digital Forensics ◽  
False Negative ◽  
False Negative Rate ◽  
Jpeg Images ◽  
Negative Rate ◽  
High False Negative Rate ◽  
Negative Study

In this study, we evaluated one of the modern automated steganalysis tools, Stegdetect, to study its false negative rates when analysing a bulk of images. In so doing, we used JPHide method to embed a randomly generated messages into 2000 JPEG images. The aim of this study is to help digital forensics analysts during their investigations by means of providing an idea of the false negative rates of Stegdetect. This study found that (1) the false negative rates depended largely on the tool’s sensitivity values, (2) the tool had a high false negative rate between the sensitivity values from 0.1 to 3.4 and (3) the best sensitivity value for detection of JPHide method was 6.2. It is therefore recommended that when analysing a huge bulk of images forensic analysts need to take into consideration sensitivity values to reduce the false negative rates of Stegdetect.

scholarly journals High False-Negative Rate for Nonalcoholic Steatohepatitis in Extreme Obesity

2016 ◽  
Vol 150 (1) ◽  
pp. 283-284 ◽  
Author(s):  
Glenn S. Gerhard ◽  
Christopher D. Still ◽  
Johanna K. DiStefano
Keyword(s):  
Nonalcoholic Steatohepatitis ◽  
False Negative ◽  
False Negative Rate ◽  
Extreme Obesity ◽  
Negative Rate ◽  
High False Negative Rate

scholarly journals A false negative study of the steganalysis tool: Stegdetect

2018 ◽  
Author(s):  
Benjamin Aziz ◽  
Jeyong Jung
Keyword(s):  
Digital Media ◽  
Digital Forensics ◽  
False Negative ◽  
False Negative Rate ◽  
Secret Data ◽  
Jpeg Images ◽  
Negative Rate ◽  
High False Negative Rate ◽  
Negative Study

Steganography and Steganalysis in recent years have become an important area of research involving dierent applications. Steganography is the process of hiding secret data into any digital media without any signicant notable changes in a cover object, while steganalysis is the process of detecting hiding content in the cover object. In this study, we evaluated one of the modern automated steganalysis tools, Stegdetect, to study its false negative rates when analysing a bulk of images. In so doing, we used JPHide method to embed a randomly generated messages into 2000 JPEG images. The aim of this study is to help digital forensics analysts during their investigations by means of providing an idea of the false negative rates of Stegdetect. This study found that (1) the false negative rates depended largely on the tool's sensitivity values, (2) the tool had a high false negative rate between the sensitivity values from 0.1 to 3.4 and (3) the best sensitivity value for detection of JPHide method was 6.2. It is recommended that when analysing a huge bulk of images forensic analysts need to take into consideration sensitivity values to reduce the false negative rates of Stegdetect.

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