John Jyoti E, Amle Dnyanesh B, Takhelmayum Roshan, Gopal Niranjan, Mishra Meena, Joshi Prashant, Rathod Bharatsing, Gadkari Rasika
Biochemistry, All India Institute of Medical Sciences, Nagpur, Nagpur, IND.
Microbiology, All India Institute of Medical Sciences, Nagpur, Nagpur, IND.
Cureus. 2022 Nov 2;14(11):e31034. doi: 10.7759/cureus.31034. eCollection 2022 Nov.
Introduction The cycle threshold (Ct) value in real-time reverse transcription-polymerase chain reaction (RT-PCR) serves as a criterion to diagnose coronavirus disease 2019 (COVID-19) and is inversely proportional to viral load. Levels of inflammatory markers such as aspartate aminotransferase (AST), ferritin, D-dimer, high sensitivity C-reactive protein (hs-CRP), and lactate dehydrogenase (LDH) are used as quantitative measures of COVID-19 severity. We examined the association between these markers and Ct values. Methodology This retrospective data analysis included 400 patients with positive RT-PCR results for COVID-19 who were admitted to a tertiary care hospital. Clinical and biochemical data were accessed from the hospital information management system. Associations of clinical parameters and markers of disease severity (e.g., polymorph, AST, hs-CRP, D-dimer, LDH, and ferritin levels) with Ct values were assessed. Observations LDH, ferritin, D-dimer, and hs-CRP were found to be significantly higher in moderate and severe groups than in the mild COVID-19 group. AST, ferritin, and hs-CRP levels were also significantly higher in severe COVID-19 subjects, compared to moderate COVID-19 subjects. Ct values for the E (envelop) gene and ORF (open reading frame) 1b gene were found to be significantly higher in those with severe COVID-19. Polymorph counts in subjects with Ct values of 25 or higher were significantly increased, compared to those with Ct values under 30. LDH, D-dimer, and hs-CRP levels in subjects with Ct values over 30 were significantly lower than for those with Ct values under 30. Ferritin was the best independent predictor of non-survival in study subjects, with an area under the curve (AUC) of 85.5% (95% confidence interval = 73.2-95.9). The Ct value for the E gene had an AUC of 75.1%, and the ORF1b gene had an AUC of 64.5%. However, no significant correlation was detected between any parameter and Ct value. Conclusion Polymorph, LDH, ferritin, D-dimer, and hs-CRP levels were significantly elevated in subjects with low E gene Ct values. Also, these subjects were at risk of severe disease and fatality. Ct values for the E gene thus could serve as an early indicator for patients at risk of severe disease and death.
引言 实时逆转录聚合酶链反应（RT-PCR）中的循环阈值（Ct）值是诊断2019冠状病毒病（COVID-19）的一个标准，且与病毒载量成反比。炎症标志物如天冬氨酸转氨酶（AST）、铁蛋白、D-二聚体、高敏C反应蛋白（hs-CRP）和乳酸脱氢酶（LDH）的水平被用作COVID-19严重程度的定量指标。我们研究了这些标志物与Ct值之间的关联。
方法 这项回顾性数据分析纳入了400例RT-PCR检测结果为COVID-19阳性且入住三级医院的患者。临床和生化数据来自医院信息管理系统。评估了临床参数和疾病严重程度标志物（如多形核白细胞、AST、hs-CRP、D-二聚体、LDH和铁蛋白水平）与Ct值之间的关联。
观察结果 发现中度和重度组的LDH、铁蛋白、D-二聚体和hs-CRP显著高于轻度COVID-19组。与中度COVID-19患者相比，重度COVID-19患者的AST、铁蛋白和hs-CRP水平也显著更高。发现重度COVID-19患者的E（包膜）基因和ORF（开放阅读框）1b基因的Ct值显著更高。Ct值为25或更高的患者的多形核白细胞计数与Ct值低于30的患者相比显著增加。Ct值超过30的患者的LDH、D-二聚体和hs-CRP水平显著低于Ct值低于30的患者。铁蛋白是研究对象非生存的最佳独立预测指标，曲线下面积（AUC）为85.5%（95%置信区间 = 73.2 - 95.9）。E基因的Ct值的AUC为75.1%，ORF1b基因的AUC为64.5%。然而，未检测到任何参数与Ct值之间存在显著相关性。
结论 E基因Ct值低的患者的多形核白细胞、LDH、铁蛋白、D-二聚体和hs-CRP水平显著升高。此外，这些患者有患重症和死亡的风险。因此，E基因的Ct值可作为重症和死亡风险患者的早期指标。
