严重急性呼吸综合征冠状病毒2逆转录聚合酶链反应的检测前症状持续时间和循环阈值可预测2019冠状病毒病死亡率。
Pretest Symptom Duration and Cycle Threshold Values for Severe Acute Respiratory Syndrome Coronavirus 2 Reverse-Transcription Polymerase Chain Reaction Predict Coronavirus Disease 2019 Mortality.
作者信息
Miller Emily Happy, Zucker Jason, Castor Delivette, Annavajhala Medini K, Sepulveda Jorge L, Green Daniel A, Whittier Susan, Scherer Matthew, Medrano Nicola, Sobieszczyk Magdalena E, Yin Michael T, Kuhn Louise, Uhlemann Anne-Catrin
机构信息
Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA.
Department of Pathology and Cell Biology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA.
出版信息
Open Forum Infect Dis. 2021 Jan 4;8(2):ofab003. doi: 10.1093/ofid/ofab003. eCollection 2021 Feb.
BACKGROUND
The relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and patient symptom duration in both in- and outpatients, and the impact of these factors on patient outcomes, are currently unknown. Understanding these associations is important to clinicians caring for patients with coronavirus disease 2019 (COVID-19).
METHODS
We conducted an observational study between March 10 and May 30, 2020 at a large quaternary academic medical center in New York City. Patient characteristics, laboratory values, and clinical outcomes were abstracted from the electronic medical records. Of all patients tested for SARS-CoV-2 during this time (N = 16 384), there were 5467 patients with positive tests, 4254 of which had available cycle threshold (Ct) values and were included in further analysis. Univariable and multivariable logistic regression models were used to test associations between Ct values, duration of symptoms before testing, patient characteristics, and mortality. The primary outcome is defined as death or discharge to hospice.
RESULTS
Lower Ct values at diagnosis (ie, higher viral load) were associated with significantly higher mortality among both in- and outpatients. It is interesting to note that patients with a shorter time since the onset of symptoms to testing had a worse prognosis, with those presenting less than 3 days from symptom onset having 2-fold increased odds of death. After adjusting for time since symptom onset and other clinical covariates, Ct values remained a strong predictor of mortality.
CONCLUSIONS
Severe acute respiratory syndrome coronavirus 2 reverse-transcription polymerase chain reaction Ct value and duration of symptoms are strongly associated with mortality. These 2 factors add useful information for clinicians to risk stratify patients presenting with COVID-19.
背景
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒载量与门诊和住院患者症状持续时间之间的关系，以及这些因素对患者预后的影响，目前尚不清楚。了解这些关联对于治疗2019冠状病毒病（COVID-19）患者的临床医生来说很重要。
方法
2020年3月10日至5月30日，我们在纽约市一家大型四级学术医疗中心进行了一项观察性研究。从电子病历中提取患者特征、实验室检查值和临床结局。在这段时间内接受SARS-CoV-2检测的所有患者（N = 16384）中，有5467例检测呈阳性，其中4254例有可用的循环阈值（Ct）值并纳入进一步分析。使用单变量和多变量逻辑回归模型来检验Ct值、检测前症状持续时间、患者特征与死亡率之间的关联。主要结局定义为死亡或转至临终关怀机构。
结果
诊断时较低的Ct值（即较高的病毒载量）与门诊和住院患者的死亡率显著升高相关。值得注意的是，从症状出现到检测的时间较短的患者预后较差，症状出现后不到3天就诊的患者死亡几率增加了2倍。在调整症状出现后的时间和其他临床协变量后，Ct值仍然是死亡率的有力预测指标。
结论
严重急性呼吸综合征冠状病毒2逆转录聚合酶链反应Ct值和症状持续时间与死亡率密切相关。这两个因素为临床医生对COVID-19患者进行风险分层提供了有用信息。
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