Universidade Federal de São Paulo (UNIFESP), Laboratório de Virologia, Division of Infectious Diseases, Department of Medicine, Escola Paulista de Medicina (EPM), São Paulo, Brazil.
Am J Trop Med Hyg. 2020 Nov;103(5):2019-2021. doi: 10.4269/ajtmh.20-0954.
There is no proven prognostic marker for patients hospitalized with COVID-19. We conducted a retrospective cohort study of patients hospitalized with COVID-19 from March 14, 2020 to June 17, 2020, at São Paulo Hospital, in São Paulo, Brazil. SARS-CoV-2 viral load was assessed using the cycle threshold (Ct) values obtained from a reverse transcription-PCR assay applied to the nasopharyngeal swab samples. The reactions were performed following the CDC U.S. protocol targeting the N1 and N2 sequences of the SARS-CoV-2 nucleoprotein gene and human ribonuclease P gene serving as an endogenous control. Disease severity and patient outcomes were compared. Among 875 patients, 50.1% (439/875) were categorized as having mild disease (nonhospitalized patients), 30.4% (266/875) moderate (hospitalized in the ward), and 19.5% (170/875) severe disease (admitted to the intensive care unit). A Ct value of < 25 (472/875) indicated a high viral load, which was independently associated with mortality (odds ratio [OR]: 2.93; 95% CI: 1.87-4.60; < 0.0001). We concluded that admission SARS-CoV-2 viral load was independently associated with mortality among patients hospitalized with COVID-19.
对于因 COVID-19 住院的患者，目前尚无明确的预后标志物。我们对 2020 年 3 月 14 日至 6 月 17 日期间在巴西圣保罗因 COVID-19 住院的患者进行了一项回顾性队列研究。使用逆转录-聚合酶链反应（RT-PCR）检测鼻咽拭子样本中 SARS-CoV-2 的 Ct 值来评估 SARS-CoV-2 病毒载量。该反应是根据美国疾病控制与预防中心（CDC）针对 SARS-CoV-2 核蛋白基因的 N1 和 N2 序列以及作为内参的人核糖核酸酶 P 基因的美国协议进行的。比较了疾病严重程度和患者结局。在 875 例患者中，50.1%（439/875）为轻症（未住院患者），30.4%（266/875）为中度（住院病房），19.5%（170/875）为重症（入住重症监护病房）。Ct 值<25（472/875）表示病毒载量高，与死亡率独立相关（比值比[OR]：2.93；95%置信区间[CI]：1.87-4.60；<0.0001）。我们得出结论，入院时 SARS-CoV-2 病毒载量与 COVID-19 住院患者的死亡率独立相关。
