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SARS-CoV-2 infection: Initial viral load (iVL) predicts severity of illness/outcome, and declining trend of iVL in hospitalized patients corresponds with slowing of the pandemic.
El Zein, Said; Chehab, Omar; Kanj, Amjad; Akrawe, Sandy; Alkassis, Samer; Mishra, Tushar; Shatta, Maya; El-Hor, Nivine; Salimnia, Hossein; Chandrasekar, Pranatharthi.
  • El Zein S; Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan, United States of America.
  • Chehab O; Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan, United States of America.
  • Kanj A; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.
  • Akrawe S; Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan, United States of America.
  • Alkassis S; Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan, United States of America.
  • Mishra T; Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan, United States of America.
  • Shatta M; Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan, United States of America.
  • El-Hor N; Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan, United States of America.
  • Salimnia H; Department of Pathology, Detroit Medical Center, Wayne State University, Detroit, Michigan, United States of America.
  • Chandrasekar P; Division of Infectious Diseases, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America.
PLoS One ; 16(9): e0255981, 2021.
Article in English | MEDLINE | ID: covidwho-1416868
ABSTRACT

BACKGROUND:

Hospitalization of patients infected with the severe acute respiratory syndrome virus 2 (SARS-CoV-2) have remained considerable worldwide. Patients often develop severe complications and have high mortality rates. The cycle threshold (Ct) value derived from nasopharyngeal swab samples using real time polymerase chain reaction (RT-PCR) may be a useful prognostic marker in hospitalized patients with SARS-CoV-2 infection, however, its role in predicting the course of the pandemic has not been evaluated thus far.

METHODS:

We conducted a retrospective cohort study which included all patients who had a nasopharyngeal sample positive for SARS-CoV-2 between April 4 -June 5, 2020. The Ct value was used to estimate the number of viral particles in a patient sample. The trend in initial viral load on admission on a population level was evaluated. Moreover, patient characteristics and outcomes stratified by viral load categories were compared and initial viral load was assessed as an independent predictor of intubation and in-hospital mortality.

RESULTS:

A total of 461 hospitalized patients met the inclusion criteria. This study consisted predominantly of acutely infected patients with a median of 4 days since symptom onset to PCR. As the severity of the pandemic eased, there was an increase in the percentage of samples in the low initial viral load category, coinciding with a decrease in deaths. Compared to an initial low viral load, a high initial viral load was an independent predictor of in-hospital mortality (OR 5.5, CI 3.1-9.7, p < 0.001) and intubation (OR 1.82 CI 1.07-3.11, p = 0.03), while an initial intermediate viral load was associated with increased risk of inpatient mortality (OR 1.9, CI 1.14-3.21, p = 0.015) but not with increased risk for intubation.

CONCLUSION:

The Ct value obtained from nasopharyngeal samples of hospitalized patients on admission may serve as a prognostic marker at an individual level and may help predict the course of the pandemic when evaluated at a population level.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Nasopharynx / Viral Load / SARS-CoV-2 / COVID-19 / Hospitalization Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged / Young adult Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2021 Document Type: Article Affiliation country: Journal.pone.0255981

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Nasopharynx / Viral Load / SARS-CoV-2 / COVID-19 / Hospitalization Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged / Young adult Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2021 Document Type: Article Affiliation country: Journal.pone.0255981