Department of Infectious Disease and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Department of Medicine, Parkview Hospital, Chittagong, Bangladesh.
J Infect Public Health. 2023 Aug;16(8):1209-1219. doi: 10.1016/j.jiph.2023.05.030. Epub 2023 May 30.
This prospective follow-up study aimed to determine the temporal changes in respiratory outcomes over 6 months period in patients with and without cancer hospitalized for severe COVID-19 and to determine the associated risk factors based on admission viral load.
All adult patients hospitalized with a confirmed diagnosis of severe SARS-CoV-2 infection were investigated using rRT-PCR on nasopharyngeal swab specimens. Patients were divided into three arbitrary groups according to their cycle threshold (C) values obtained at admission as high (C<25.0), medium (C between 25.0 and 30.0), and low (C>30.0) viral load. Patients had pulmonary function tests, chest high-resolution computed tomography (HRCT), and a 6-minute walking time distance measured at each follow-up visit.
This follow-up study had a total of 112 participants, of which 75 were cancer-free and 37 had active cancer. Overall, 29.5% had a low viral load, compared to 48.2% who had a high viral load, and 22.3% had a medium viral load. For patients who did not have cancer, the mean age was 57.3 (SD 15.4) and for those who had cancer, it was 62.3 (SD 18.4). Most patients had overall better temporal changes in pulmonary function and tolerance, as well as exercise capacity, even though severe and chronic respiratory abnormalities persisted in a fraction of the patients. In patients without cancer who had a high viral load, we have seen a substantial reduction in diffusion capacity of the lungs for carbon monoxide (DLCO) predicted value with a median of 65 (IQR 63-70) while in patients with cancer, it was 60 (IQR 56-67) at 2 months. At 4 and 6 months, the predicted DLCO values for patients without cancer were 65 (IQR 61-70), whereas the predicted DLCO values for patients with active cancer were 62 (IQR 60-67) and 67 (59-73). Importantly, radiological abnormalities persisted in 22 (29%) non-cancer patients and 16 (43%) cancer patients. Multivariate regression analysis showed an increased odds ratio of impaired HRCT associated with a high viral load of 3.04 (95% CI:1.68-6.14; p < 0.001) for patients without cancer and 5.07 (95% CI: 4.04-10.8; p < 0.0001) for patients with cancer. The CT pneumonia score at hospitalization was 2.25 (95% CI:1.76-3.08; p = 0.041) and 2.85 (95% CI:1.89-5.14; p = 0.031) for non-cancer and cancer patients respectively.
The evidence of persistent pulmonary abnormalities and radiographic changes was found in both patient groups who had high viral load at hospital admission and suggesting that SARS-CoV-2 viral load might serve as a useful indicator to predict the development of respiratory complications in patients with COVID-19.
本前瞻性随访研究旨在确定患有和不患有癌症的因严重 COVID-19 住院的患者在 6 个月期间的呼吸结局的时间变化，并根据入院时的病毒载量确定相关的危险因素。
所有经鼻咽拭子标本实时逆转录聚合酶链反应（rRT-PCR）确诊为严重 SARS-CoV-2 感染的成年患者均接受了研究。根据入院时获得的循环阈值（C）值，患者被分为三组：高病毒载量（C<25.0）、中病毒载量（C 在 25.0 和 30.0 之间）和低病毒载量（C>30.0）。患者在每次随访时均接受肺功能测试、胸部高分辨率计算机断层扫描（HRCT）和 6 分钟步行时间距离测量。
本随访研究共纳入 112 名参与者，其中 75 名无癌症，37 名患有活动性癌症。总体而言，29.5%的患者病毒载量较低，48.2%的患者病毒载量较高，22.3%的患者病毒载量中等。对于无癌症的患者，平均年龄为 57.3（标准差 15.4），对于患有癌症的患者，平均年龄为 62.3（标准差 18.4）。尽管部分患者仍存在严重和慢性的呼吸异常，但大多数患者的肺功能和耐受性以及运动能力均有较好的时间变化。在无癌症且病毒载量较高的患者中，我们发现一氧化碳弥散量（DLCO）预计值显著降低，中位数为 65（IQR 63-70），而在患有癌症的患者中，中位数为 60（IQR 56-67），在 2 个月时。在 4 个月和 6 个月时，无癌症患者的预计 DLCO 值为 65（IQR 61-70），而活动性癌症患者的预计 DLCO 值分别为 62（IQR 60-67）和 67（59-73）。重要的是，22 名（29%）非癌症患者和 16 名（43%）癌症患者仍存在放射学异常。多变量回归分析显示，无癌症患者 HRCT 异常与高病毒载量的比值比（OR）为 3.04（95%CI：1.68-6.14；p<0.001），癌症患者为 5.07（95%CI：4.04-10.8；p<0.0001）。非癌症和癌症患者的住院时 CT 肺炎评分分别为 2.25（95%CI：1.76-3.08；p=0.041）和 2.85（95%CI：1.89-5.14；p=0.031）。
入院时病毒载量较高的两组患者均发现存在持续的肺部异常和放射学变化的证据，这表明 SARS-CoV-2 病毒载量可能是预测 COVID-19 患者发生呼吸并发症的有用指标。
