Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at the Amedeo di Savoia Hospital, Corso Svizzera 164, 10149 Torino, Italy.
Microbiology and Molecular Biology Laboratory, Amedeo di Savoia Hospital, ASL Città di Torino, Corso Svizzera 164, 10149 Torino, Italy.
Viruses. 2021 Feb 11;13(2):281. doi: 10.3390/v13020281.
To date, there is no severe acute respiratory syndrome coronavirus 2-(SARS-CoV-2)-specific prognostic biomarker available. We assessed whether SARS-CoV-2 cycle threshold (Ct) value at diagnosis could predict novel CoronaVirus Disease 2019 (COVID-19) severity, clinical manifestations, and six-month sequelae. Hospitalized and outpatient cases were randomly sampled from the diagnoses of March 2020 and data collected at 6 months by interview and from the regional database for COVID-19 emergency. Patients were stratified according to their RNA-dependent-RNA-polymerase Ct in the nasopharyngeal swab at diagnosis as follows: Group A ≤ 20.0, 20.0 < group B ≤ 28.0, and Group C > 28.0. Disease severity was classified according to a composite scale evaluating hospital admission, worst oxygen support required, and survival. Two hundred patients were included, 27.5% in Groups A and B both, 45.0% in Group C; 90% of patients were symptomatic and 63.7% were hospitalized. The median time from COVID-19 onset to swab collection was five days. Lethality, disease severity, type, and number of signs and symptoms, as well as six-month sequelae distributed inversely among the groups with respect to SARS-CoV-2 Ct. After controlling for confounding, SARS-CoV-2 Ct at diagnosis was still associated with COVID-19-related death ( = 0.023), disease severity ( = 0.023), number of signs and symptoms ( < 0.01), and presence of six-month sequelae ( < 0.01). Early quantification of SARS-CoV-2 may be a useful predictive marker to inform differential strategies of clinical management and resource allocation.
截至目前，尚无针对严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的特异性预后生物标志物。我们评估了诊断时的 SARS-CoV-2 循环阈值（Ct）值是否可以预测新型冠状病毒病 2019（COVID-19）的严重程度、临床表现和六个月后的后遗症。从 2020 年 3 月的诊断中随机抽取住院和门诊病例，并通过访谈和区域 COVID-19 应急数据库收集 6 个月的数据。根据鼻咽拭子中 RNA 依赖性 RNA 聚合酶的 Ct 值将患者分层如下：A 组≤20.0，20.0<B 组≤28.0，C 组>28.0。根据评估住院、所需最差氧气支持和存活的综合量表对疾病严重程度进行分类。共纳入 200 例患者，A 组和 B 组各占 27.5%，C 组占 45.0%；90%的患者有症状，63.7%的患者住院。从 COVID-19 发病到拭子采集的中位时间为 5 天。病死率、疾病严重程度、类型和体征及症状的数量以及六个月后的后遗症在 SARS-CoV-2 Ct 方面呈相反分布。在控制混杂因素后，诊断时的 SARS-CoV-2 Ct 仍与 COVID-19 相关死亡（ = 0.023）、疾病严重程度（ = 0.023）、体征及症状数量（ < 0.01）和六个月后的后遗症（ < 0.01）相关。早期定量 SARS-CoV-2 可能是一种有用的预测标志物，可用于告知临床管理和资源分配的差异化策略。
