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. 2021 Feb 1;7(2):e41. doi: 10.1192/bjo.2020.167
Laboratory examination Lab tests at admission: differential blood count, C-reactive protein (CRP), procalcitonin (PCT), interleukin (IL)-6, kidney and liver values, troponin T, pro-brain natriuretic peptide, immunoglobulin, lymphocyte subpopulation, lactate dehydrogenase (LDH), ferritin, coagulation, D-dimer, lactate, beta-human chorionic gonadotropin in female patients of childbearing age.
Daily lab tests: depend on clinical symptoms, important for course of disease: PCT, IL-6, D-dimer, ferritin, differential blood count, liver values, troponin T.
Typical changes
  • (a)

    Leucopenia, lymphopenia: frequently, thrombocytopenia (mild) in up to 35% of patients, eosinopenia in up to 52%.

  • (b)

    CRP increase (in 61–86%) (>10; mostly 10 to 20).

  • (c)

    LDH increase (in 27–75%).

  • (d)

    PCT increase (in 24%, especially in patients in intensive care units).

  • (e)

    Aspartate aminotransaminase/alanine aminotransaminase increase (in 4–22%).

  • (f)

    Troponin increase.5

Caveat: Cardiomyopathy with troponin increase is a predictor for increased mortality, especially if troponin increases continuously from day 4. Troponin control is strongly recommended. Troponin increases seem to be connected to a COVID-19-associated cardiomyopathy rather than a myocardial infarction.
Medical imaging
  • (a)

    In conventional chest X-ray, changes are visible in 50–60% of patients. However, in computed tomography (CT) scans changes are visible in approximately 85% of cases as ground glass opacity (GGO), bilateral, less frequently unilateral infiltration (14–25%) or increase of interstitial markings (Source: Robert Koch Institute, https://www.rki.de).

  • (b)

    Chest CT (non-contrast): at admission and for further assessment of course of disease in case of clinical worsening. Long-range indication advisable!

  • (c)

    CT has higher sensitivity than chest X-ray: chest X-ray abnormal in >60% of patients, CT abnormal in >85%.

  • (d)

    Typical changes: GGO; bilateral, less frequently unilateral infiltration (14–25%), possible increase of interstitial markings.

Virological examinations
  • (a)

    Polymerase chain reaction (PCR): most sensitive non-invasive test.

  • (b)

    First sample: PCR from deep nasal/throat swab; sensitive in first week (replicative phase in throat area). In case of negative test result but continued clinical suspicion, a second test is advisable.

  • (c)

    Second sample: lower respiratory passages, for example tracheobronchial secretion (extraction, no bronchoalveolar lavage) or sputum. If pulmonic-infiltrated sputum is detected, then nasal/throat swab (progressive disease). In case of typical clinical picture (and CT) and negative PCR, isolation should be maintained and test repeated.

  • (d)

    Optional: Influenza A/B and respiratory syncytial virus (quick test).

  • (e)

    In case of clinical suspicion: sputum bacteriology + mycoplasma + sputum for extensive PCR.

  • (f)

    Legionella urinary antigen test.

  • (g)

    Organ- or bone marrow-transplanted/immune-suppressed patients (tumour necrosis factor inhibition): Epstein–Barr virus/cytomegalovirus PCR, adeno-PCR.

  • (h)

    Aspergillus antigen and beta-glucan in case of clinical suspicion.

  • (i)

    Blood cultures in case of fever and before empirical antibiosis.