Abstract
The Infectious Diseases Society of America has identified the use of SARS-CoV-2 genomic load for prognostication purposes as a key research question. We designed a retrospective cohort study that included adult patients with COVID-19 pneumonia who had at least 2 positive nasopharyngeal tests at least 24 hours apart to study the correlation between the change in the genomic load of SARS-CoV-2, as reflected by the Cycle threshold (Ct) value of the RT-PCR, with change in clinical status. The Sequential Organ Failure Assessment (SOFA) score was used as a surrogate for patients’ clinical status. Among 457 patients with COVID-19 pneumonia between 3/31/2020-4/10/2020, we identified 42 patients who met the inclusion criteria. The median initial SOFA score was 2 (IQR 2–3). 20 out of 42 patients had a lower SOFA score on their subsequent tests. We identified a statistically significant inverse correlation between the change in SOFA score and change in the Ct value with a decrease in SOFA score by 0.05 (SE 0.02; p<0.05) for an increase in Ct values by 1. This correlation was independent of the duration of symptoms. Our findings suggest that an increasing Ct value in sequential tests may be of prognostic value for patients diagnosed with COVID-19 pneumonia.
Highlights
The World Health Organization declared Coronavirus Disease 2019 (COVID-19), the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a pandemic on March 11th, 2020 [1]
We examined the correlation between the SARS-CoV-2 genomic load and the change in clinical status, as reflected by the Sequential Organ Failure Assessment (SOFA) score, among patients who had repeat testing with the Cepheid Xpert1 Xpress SARS-CoV-2 assay
We identified 42 patients who were diagnosed with COVID-19 pneumonia between March 31st, 2020 to April 10th and had repeatedly tested positive over a month follow up period between 2–11 times
Summary
The World Health Organization declared Coronavirus Disease 2019 (COVID-19), the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a pandemic on March 11th, 2020 [1]. At the time of this writing, SARS-CoV-2 has infected more than 40 million people and has caused more than 1 million deaths worldwide [2]. Disease severity ranges from asymptomatic or minimally symptomatic infection to hypoxic respiratory failure and death [3]. Viral factors might predict disease outcomes, but few clinical studies have focused on elucidating their role. The Infectious Diseases Society of America has recently emphasized that the ability of a quantitative test for SARS-CoV-2 to be used as a prognostic marker remains a key research question [6]
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