Atique Muhammad, Ghafoor Atif, Javed Rabia, Fatima Noor, Yousaf Anam, Zahra Samana
Histopathology, Pakistan Kidney and Liver Institute & Research Center, Lahore, PAK.
Molecular Biology, Pakistan Kidney and Liver Institute & Research Center, Lahore, PAK.
Cureus. 2021 Jul 27;13(7):e16655. doi: 10.7759/cureus.16655. eCollection 2021 Jul.
Background/objective Coronavirus infectious disease (COVID-19) is a novel disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Some studies have shown that disease severity according to clinical and biochemical parameters are in direct relation to viral load while others have found no direct correlation. In this study, the COVID-19 cycle threshold (Ct) value, which is taken as a direct indicator of the viral load, has been correlated with the biochemical and clinical parameters in COVID-19 patients. Methods In this cross-sectional, retrospective, and single-center study, 365 patients admitted with COVID 19 were divided into three groups according to their Ct values obtained from reverse transcription-polymerase chain reaction RT-PCR as 1 (9-20), 2 (21-30), and 3 (31-40). The correlation of the COVID-19 Ct value with biochemical parameters and clinical presentation (taken as mild, moderate, and severe) was done and analyzed. The chi-square test was used for the correlation and calculated by using SPSS V-24.0 (IBM Corp., Armonk, NY). p-value <0.05 was considered significant statistically. Results Disease severity levels (mild, moderate, and severe) correlated in group 1 (Ct value 9 to 20), 2 (Ct value 21 to 30), and 3 (Ct value 31 to 40) but no significance was found between disease severity levels and the Ct value groups' p-value (>0.05). All the biochemical parameters analyzed (alanine transaminase (ALT), aspartate aminotransferase (AST), albumin, bilirubin, c-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, D-dimer, and total leucocyte count (TLC)) showed a significant p-value (<0.05) in all the three groups studied. Procalcitonin (PCT), however, did not show any significant value in any of the groups studied. In the intergroup assessment, it was found that the values of ALT, AST, albumin, CRP, ferritin, bilirubin, and TLC are maximum in group 2 with a downward trend in groups 1 and 2. Neutrophils and lymphocytes did not show any variations. LDH did not follow the trend of increasing viral load. Conclusions The severity of the disease was not statistically significant in the Ct value groups (p> 0.05). However biochemical parameters, i.e. ALT, AST, ALP, CRP, and bilirubin were statistically significant (p<0.05). Patients with COVID-19 should be closely monitored for the assessment of disease progression according to the above-mentioned biochemical parameters.
背景/目的 冠状病毒感染性疾病（COVID-19）是由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的一种新型疾病。一些研究表明，根据临床和生化参数判断的疾病严重程度与病毒载量直接相关，而另一些研究则未发现直接相关性。在本研究中，COVID-19循环阈值（Ct）值被视为病毒载量的直接指标，并与COVID-19患者的生化和临床参数进行了关联分析。方法 在这项横断面、回顾性、单中心研究中，365例因COVID-19入院的患者根据其逆转录-聚合酶链反应（RT-PCR）获得的Ct值分为三组：1组（9-20）、2组（21-30）和3组（31-40）。对COVID-19的Ct值与生化参数及临床表现（分为轻、中、重度）进行关联分析。采用卡方检验进行相关性分析，并使用SPSS V-24.0（IBM公司，纽约州阿蒙克）进行计算。p值<0.05被认为具有统计学意义。结果 1组（Ct值9至20）、2组（Ct值21至30）和3组（Ct值31至40）的疾病严重程度水平存在相关性，但疾病严重程度水平与Ct值组之间未发现显著差异（p值>0.05）。所有分析的生化参数（丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、白蛋白、胆红素、C反应蛋白（CRP）、乳酸脱氢酶（LDH）、铁蛋白、D-二聚体和白细胞总数（TLC））在所有三个研究组中均显示出显著的p值（<0.05）。然而，降钙素原（PCT）在任何研究组中均未显示出显著值。在组间评估中，发现ALT、AST、白蛋白、CRP、铁蛋白、胆红素和TLC的值在2组中最高，在1组和3组中呈下降趋势。中性粒细胞和淋巴细胞未显示出任何变化。LDH未遵循病毒载量增加的趋势。结论 Ct值组中疾病严重程度无统计学意义（p>0.05）。然而，生化参数，即ALT、AST、碱性磷酸酶（ALP）、CRP和胆红素具有统计学意义（p<0.05）。应根据上述生化参数密切监测COVID-19患者，以评估疾病进展。
