Evaluation of Association Between Ct Value of SARS-COV-2 PCR with Disease Progression and Mortality/SARS-CoV-2 PCR Dongu Esik Degeri ile Klinik Seyir ve Mortalite Iliskisinin Degerlendirilmesi

• Published in: KLIMIK dergisi Vol. 35; no. 3; p. 126
• Main Authors: Demir-Onder, Kubra, Seremet-Keskin, Aysegul, Erman-Daloglu, Aylin, Balci, Umay, User, Ulku
• Format: Journal Article
• Language: English
• Published: DOC Design and Informatics Co. Ltd 01.09.2022
• Subjects: Analysis; Bacterial pneumonia; Development and progression; Health aspects; Medical research; Medicine, Experimental; Mortality; Pneumonia; Taiwan; Taiwan
• ISSN: 1301-143X; 1309-1484
• DOI: 10.36519/kd.2022.4190

Objective: Multiple factors have been studied in association with disease severity in COVID-19. The cycle threshold (Ct) value of polymerase chain reaction (PCR) can reflect viral load in the specimens. In this study, we aimed to evaluate the effect of the Ct value on clinical course and mortality in COVID-19 patients. Methods: Adult patients who tested positive for SARS-CoV-2 with PCR test and who were hospitalized with COVID-19- related symptoms between August 1, 2020, and November 30, 2020, were included in the study. In addition, Ct value, demographic and clinical data (length of hospital stay, need for admission to intensive care unit (ICU), need for mechanical ventilation (MV), and mortality) were reviewed retrospectively. Results: 117 patients were included in the study. The mean Ct value was 22.37 [+ or -] 4.72 (11.07-34.06). There was no significant difference in the mean Ct values between the patients who needed ICU admission and those who did not. When the patients were evaluated by dividing them into three groups according to their Ct values, as < 20, between 20-24 and >24; there was no significant difference between these three groups in terms of severity of pneumonia, laboratory parameters (D-dimer, Neutrophil/Lymphocyte ratio, C-reactive protein, lymphocyte count), length of hospital stay, need for ICU admission, need for MV and mortality. When the patients were divided into two groups with Ct values as <23.3 and [greater than or equal to] 23.3, no significant difference was found between the groups regarding ICU need, MV need, and 28-day mortality rates. Conclusion: Most of the studies in the literature about Ct value and its effect on clinical course indicate that lower Ct values are potentially associated with worse outcomes in COVID-19. However, there are also studies reporting that the Ct value does not reflect the severity of the disease. We did not find a correlation between Ct value and laboratory markers, length of hospital stay, the severity of pneumonia, need for ICU admission or MV, and mortality in COVID19 patients in this presented study. Keywords: Ct value, cycle threshold, COVID-19, clinical course, mortality Amac: Siddetli akut solunum yolu sendromu virusunun (SARS-CoV-2) neden oldugu koronavirus hastaligi (COVID-19), asemptomatik infeksiyondan olumle sonuclanabilecek siddetli hastaliga kadar degisen klinik tablolara neden olabilmektedir. Klinik seyrin kotulesmesine pek cok faktor etki etmektedir. Bu calismada, viral yukun gostergesi olabilecek ve SARS-CoV-2 spesifik gercek zamanli revers transkriptaz polimeraz zincir reaksiyonu (RT-PCR) testinde elde edilen dongu esik ("cycle threshold, Ct") degerinin klinik gidis ve mortalite uzerine etkisinin degerlendirilmesi amaclanmistir. Yontemler: RT-PCR testi, 01 Agustos--30 Kasim 2020 tarihleri arasinda, hastanemiz tibbi mikrobiyoloji laboratuvarinda calisildi. Test sonucu pozitif olan COVID-19 iliskili semptom ve bulgularla hastaneye yatirilan eriskin 117 hasta calismaya alindi. Hastalara ait laboratuvar parametreleri, toraks tomografisi bulgulari, yatis suresi, yogun bakim (YB) ihtiyaci, mekanik ventilator (MV) ihtiyaci ve mortalite durumlari ile tani anindaki PCR test sonuclarindaki Ct degerleri kaydedildi. Ardindan Ct degeri ile kotu klinik gidis ve mortalite arasinda iliski olup olmadigi degerlendirildi. Bulgular: Tum hastalarin Ct degeri ortalamasi 22.37 [+ or -] 4.72 (11.07-34.06) olarak saptandi. YB ihtiyaci olan ve olmayan hastalar arasinda Ct degeri ortalamalari acisindan anlamli fark saptanmadi. Hastalar Ct degerlerine gore <20 olanlar (n=37), 20-24 arasinda olanlar (n=38) ve >24 olanlar (n=42) seklinde uc gruba ayrilarak degerlendirildiginde; yas, cinsiyet, komorbidite, pnomoninin siddeti, D-dimer, notrofil/lenfosit (N/L) orani, C-reaktif protein (CRP), lenfosit sayisi gibi laboratuvar parametrelerinin duzeyi, yatis suresi, YB ihtiyaci, MV ihtiyaci ve mortalite acisindan bu uc grup arasinda anlamli fark saptanmadi. Ct degeri siniri <23.3 ve [greater than or equal to] 23.3 olarak iki gruba ayrildiginda da YB ihtiyaci, MV ihtiyaci ve 28 gun olan mortalite orani acisindan gruplar arasinda anlamli fark saptanmadi. Sonuclar: Literaturde, COVID-19 hastaliginda tespit edilen Ct degeri ile kotu prognoz ve mortalite iliskisini inceleyen cesitli calismalarda celiskili sonuclar bildirilmistir. Calismalarin cogunda dusuk Ct degeri ve hastalik progresyonu arasinda iliski saptandigi bildirilmis olmasina karsin calismamizda Ct degeri ile kotu klinik gidisat, hastalik progresyonunu isaret eden laboratuvar parametreleri, yatis suresi, pnomoni siddeti, YB ihtiyaci, MV ihtiyaci ve mortalite arasinda anlamli iliski saptanmadi. Anahtar sozcukler: Ct degeri, dongu esigi, COVID-19, klinik seyir, mortalite