The real-time reverse transcription-polymerase chain reaction threshold cycle values for severe acute respiratory syndrome coronavirus 2 predict the prognosis of coronavirus disease 2019 pneumonia

Fukushima, Takahiro; Kabata, Hiroki; Yamamoto, Ryo; Suhara, Tomohiro; Uwamino, Yoshifumi; Kondo, Yasushi; Masaki, Katsunori; Kamata, Hirofumi; Nagata, Hiromasa; Homma, Koichiro; Kaneko, Yuko; Ishii, Makoto; Sasaki, Junichi; Morisaki, Hiroshi; Hasegawa, Naoki; Fukunaga, Koichi

doi:10.1016/j.resinv.2020.12.011

Cited by 7 publications

(6 citation statements)

References 8 publications

(8 reference statements)

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“…Our results with a SARS-CoV-2 population, from a cohort that is different from those in previous studies on the influence of viral load on disease, suggest a positive association between viral load and COVID-19 disease severity. This conclusion is in agreement with many studies to date [5–10, 12–15, 28, 29] (see also [16] for a review), but in contrast, others did not show such an association [17–22]. A possibility to explain such disparate conclusions is the multiple differential criteria considered among studies, such as the sample size, the genomic region analysed, the clinical severity of the patients to be compared, or the standards to classify patients in clinical categories, among other features.…”

Section: Discussionsupporting

confidence: 88%

“…For example, a longer persistence of high viral load viruses in respiratory samples of patients with severe disease than those with mild disease has been reported, suggesting that viral load may be a prognostic parameter [30, 31]. Ct values on admission were also predictors of COVID-19 severity in a small Japanese cohort of ICU patients ( n =19) whose clinical classification as ‘critical’ and ‘non-critical’ illness was based on their oxygen demand during hospitalization [28]. In a large cohort of 4254 patients in a New York City medical centre, inpatients had significantly higher Ct values than outpatients, and lower Ct values at admission were significantly associated with mortality [29].…”

Section: Discussionmentioning

confidence: 99%

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High SARS-CoV-2 viral load is associated with a worse clinical outcome of COVID-19 disease

Soria

Cortón

Martínez-González

et al. 2021

Access Microbiology

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COVID-19 severity and progression are determined by several host and virological factors that may influence the final outcome of SARS-CoV-2-infected patients. The objective of this work was to determine a possible association between viral load, obtained from nasopharyngeal swabs, and the severity of the infection in a cohort of 448 SARS-CoV-2-infected patients from a hospital in Madrid during the first outbreak of the pandemic in Spain. To perform this, we clinically classified patients as mild, moderate and severe COVID-19 according to a number of clinical parameters such as hospitalization requirement, need of oxygen therapy, admission to intensive care units and/or death. Also, Ct values were determined using SARS-CoV-2-specific oligonucleotides directed to ORF1ab. Here we report a statistically significant association between viral load and disease severity, a high viral load being associated with worse clinical prognosis, independently of several previously identified risk factors such as age, sex, hypertension, cardiovascular disease, diabetes, obesity and lung disease (asthma and chronic obstructive pulmonary disease). The data presented here reinforce viral load as a potential biomarker for predicting disease severity in SARS-CoV-2-infected patients. It is also an important parameter in viral evolution since it relates to the numbers and types of variant genomes present in a viral population, a potential determinant of disease progression.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

High SARS-CoV-2 viral load is associated with a worse clinical outcome of COVID-19 disease

Soria

Cortón

Martínez-González

et al. 2021

Access Microbiology

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“…We assumed that the false-negative RT-PCR results of two patients with severe disease was due to low viral loads, and that their clinical deterioration was due to high cytokine levels, which made diagnosis and clinical management challenging. Generally, high Ct values, reflecting low viral load levels on RT-PCR testing, predicts disease of mild severity; however, this is not applicable in cases with delayed testing [20] . It is essential for clinicians to confirm the time since symptom onset patients suspected to have COVID-19 with negative RT-PCR results.…”

Section: Discussionmentioning

confidence: 99%

False-negative rate of SARS-CoV-2 RT-PCR tests and its relationship to test timing and illness severity: A case series

Takahashi

Ichinose

Okada

2022

IDCases

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“… 34 , 35 However, the Ct values proposed by other groups as predictive of severe disease are similar to those we identified. 36 , 37 Importantly, none of these studies looked at the combined predictive power of the Ct value and haematologic parameters.…”

Section: Discussionmentioning

confidence: 99%

Combination of cycle threshold time, absolute lymphocyte count and neutrophil:lymphocyte ratio is predictive of hypoxia in patients with SARS-CoV-2 infection

Abeysuriya

Seneviratne

Silva

et al. 2021

Transactions of the Royal Society of Tropical Medicine and Hygiene

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Background There is currently no clinically validated biomarker to predict respiratory compromise in sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cycle threshold time (Ct), absolute lymphocyte count (AL) and neutrophil:lymphocyte ratio (NLR) have been previously evaluated for this purpose. We hypothesized that the combination of these parameters at presentation may be predictive of hypoxia (oxygen saturation <92%). Methods Data were collected on 118 patients with SARS-CoV-2 infection between May 2020 and April 2021. Demographics, clinical parameters and laboratory and radiological investigation results were recorded. Respiratory compromise (RC) was defined based on symptoms and signs, hypoxia and chest X-ray abnormalities. Results RC occurred in 61 (51.7%) of patients. The Ct, AL and NLR at median day 3 of illness were significantly different between patients with and without RC (Ct, RC vs not: 19.46±2.64 vs 22.62±3.37, p=0.0001; AL, RC vs not: 531.49±289.09 vs 764.69±481.79, p=0.0001; NLR, RC vs not: 3.42±0.75 vs 2.59±0.55, p=0.0001). Receiver operating characteristics analysis showed that a Ct <19.9, AL <630.8×103/μL and NLR >3.12 at median day 3 of symptoms was predictive of hypoxia on day 7 of illness (area under the curve 0.805, sensitivity 96.7%, specificity 69.1%). The predictive value for the parameters combined was significantly superior to their individual predictive power. Conclusions Ct, AL and NLR used in combination on day 3 of symptoms are predictive of hypoxia on day 7 of SARS-CoV-2 illness.

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The real-time reverse transcription-polymerase chain reaction threshold cycle values for severe acute respiratory syndrome coronavirus 2 predict the prognosis of coronavirus disease 2019 pneumonia

Cited by 7 publications

References 8 publications

High SARS-CoV-2 viral load is associated with a worse clinical outcome of COVID-19 disease

High SARS-CoV-2 viral load is associated with a worse clinical outcome of COVID-19 disease

False-negative rate of SARS-CoV-2 RT-PCR tests and its relationship to test timing and illness severity: A case series

Combination of cycle threshold time, absolute lymphocyte count and neutrophil:lymphocyte ratio is predictive of hypoxia in patients with SARS-CoV-2 infection

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