Diagnostic SARS-CoV-2 Cycle Threshold Value Predicts Disease Severity, Survival, and Six-Month Sequelae in COVID-19 Symptomatic Patients
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Population
3.2. COVID-19 Outcomes According to SARS-CoV-2 Ct
3.3. Clinical Presentation at Diagnosis According to SARS-CoV-2 Ct
3.4. Six-Month Sequelae According to SARS-CoV-2 Ct
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Population |
---|---|
(n = 200) | |
Median SARS-CoV-2 PCR Ct | |
Group A, Ct ≤ 20.0 | 18.9 (17.9–19.5) |
Group B, 20.0 < Ct ≤ 28.0 | 22.9 (22.0–25.2) |
Group C, Ct > 28.0 | 34.0 (30.8–36.9) |
Hospital admissions, n | 127 (63.5%) |
Symptomatic, n | 180 (90.0%) |
Signs and symptoms according to main systems, n | |
Systemic inflammatory involvement | 166 (83.0%) |
Neurological involvement | 73 (36.5%) |
Gastroenterological involvement | 35 (17.5%) |
Respiratory involvement | 131 (65.5%) |
Time between symptoms onset and diagnostic swab collection, days * | 5 (3–8) |
Outcomes, n | |
Complete recovery | 127 (63.5%) |
Sequelae | 41 (20.5%) |
Death | 32 (16.0%) |
Type of Sequelae, n | |
Dyspnea | 21 (12.5%) |
Olfactory and/or gustatory dysfunction | 13 (7.7%) |
Chronic cough | 7 (4.2%) |
Others | 6 (3.6%) |
Worst oxygen support, n | |
None | 99 (49.5%) |
Wall low-flow oxygen to reservoir | 60 (30.0%) |
CPAP | 29 (14.5%) |
Intubation | 12 (6.0%) |
Comorbidities, n | |
None | 82 (41.0%) |
Hypertension | 56 (28.0%) |
COPD/asthma | 33 (16.5%) |
Overweight/obesity | 27 (13.5%) |
Active smoking | 23 (11.5%) |
Diabetes | 19 (9.5%) |
Cancer | 17 (8.5%) |
Others | 46 (23.0%) |
Disease severity, n | |
Home isolation | 73 (36.5%) |
Hospital admission without oxygen support | 26 (13.0%) |
Hospital admission with low-flow oxygen to reservoir | 39 (19.5%) |
Hospital admission with CPAP | 20 (10.0%) |
Hospital admission with intubation | 10 (5.0%) |
Death | 32 (16.0%) |
A | B | C | p | η2 | A vs. B * | A vs. C * | B vs. C * | |
---|---|---|---|---|---|---|---|---|
Ct ≤ 20 | 20 < Ct ≤ 28 | Ct > 28 | ||||||
(n = 55) | (n = 55) | (n = 90) | ||||||
Age, years | 64 (39–78) | 57 (50–67) | 52 (40–63) | 0.017 | 0.396 | 0.381 | 0.011 | 0.025 |
Male sex, n | 31 (56.4%) | 32 (58.2%) | 53 (58.9%) | 0.956 | - | 0.848 | 0.766 | 0.933 |
Comorbidity, n | ||||||||
None | 15 (27.3%) | 23 (41.8%) | 49 (54.4%) | 0.006 | 0.052 | 0.375 | 0.004 | 0.413 |
Hypertension | 27 (49.1%) | 13 (23.6%) | 16 (17.8%) | <0.0005 | 0.077 | <0.0005 | 0.009 | 0.999 |
COPD/asthma | 12 (21.8%) | 6 (10.9%) | 15 (16.7%) | 0.306 | - | 0.124 | 0.441 | 0.341 |
Overweight/obesity | 8 (14.5%) | 8 (14.5%) | 11 (12.2%) | 0.892 | - | 0.999 | 0.689 | 0.689 |
Active Smoking | 12 (21.8%) | 2 (3.6%) | 9 (10.0%) | 0.01 | 0.017 | 0.009 | 0.093 | 0.735 |
Diabetes | 8 (14.5%) | 6 (10.9%) | 5 (5.6%) | 0.186 | - | 0.569 | 0.067 | 0.239 |
Cancer | 5 (9.1%) | 5 (9.1%) | 7 (7.8%) | 0.947 | - | 0.999 | 0.781 | 0.781 |
Others | 11 (20.0%) | 19 (34.5%) | 16 (17.8%) | 0.08 | - | 0.164 | 0.515 | 0.028 |
Time from COVID-19 onset to swab collection, days | 3 (2–5) | 5 (3–9) | 5 (3–10) | 0.011 | 0.144 | 0.02 | 0.026 | 0.999 |
Number of signs and symptoms at diagnosis, n | 4 (3–6) | 3 (2–4) | 3 (2–3) | 0.007 | 0.058 | 0.037 | 0.008 | 0.977 |
Hospital admissions, n | 41 (74.5%) | 35 (63.6%) | 51 (56.7%) | 0.096 | - | 0.218 | 0.031 | 0.409 |
Worst oxygen support, n | 0.495 | - | 0.923 | 0.28 | 0.377 | |||
None | 24 (43.6%) | 28 (50.9%) | 47 (52.2%) | |||||
Low-flow wall oxygen to reservoir | 20 (36.4%) | 11 (20.0%) | 29 (32.2%) | |||||
CPAP | 7 (12.7%) | 11 (20.0%) | 11 (12.2%) | |||||
Intubation | 4 (7.3%) | 5 (9.1%) | 3 (3.3%) | |||||
Outcomes, n | <0.0005 | 0.191 | <0.0005 | <0.0005 | 0.678 | |||
Complete recovery | 16 (29.1%) | 39 (70.9%) | 72 (80.0%) | |||||
Sequelae | 19 (34.5%) | 9 (16.4%) | 13 (14.4%) | |||||
Death | 20 (36.4%) | 7 (12.7%) | 5 (5.6%) | |||||
Disease severity, n | 0.004 | 0.169 | 0.204 | 0.003 | 0.62 | |||
Home isolation | 14 (25.4%) | 20 (36.4%) | 39 (43.3%) | |||||
Hospital admission: | ||||||||
Without oxygen support | 10 (18.2%) | 8 (14.5%) | 8 (8.9%) | |||||
With low-flow wall oxygen to reservoir | 5 (9.1%) | 8 (14.5%) | 26 (28.9%) | |||||
With CPAP | 3 (5.4%) | 7 (12.7%) | 10 (11.1%) | |||||
With intubation | 3 (5.4%) | 5 (9.1%) | 2 (2.2%) | |||||
Death | 20 (36.4%) | 7 (12.7%) | 5 (5.6%) | |||||
A | B | C | p | η2 | A vs. B * | A vs. C * | B vs. C * | |
Ct ≤ 20 | 20 < Ct ≤ 28 | Ct > 28 | ||||||
(n = 35) | (n = 48) | (n = 85) | ||||||
Outcomes among survivors, n | <0.0005 | 0.162 | 0.001 | <0.0005 | 0.999 | |||
Complete recovery | 16 (45.7%) | 39 (81.2%) | 72 (84.7%) | |||||
Sequelae | 19 (54.3%) | 9 (18.8%) | 13 (15.3%) | |||||
Type of Sequelae, n | ||||||||
Dyspnea | 11 (57.9%) | 1 (11.1%) | 9 (69.2%) | 0.022 | 0.004 | 0.067 | 0.999 | 0.024 |
O/G dysfunction | 6 (31.6%) | 4 (44.4%) | 3 (23.1%) | 0.579 | - | 0.677 | 0.704 | 0.376 |
Chronic cough | 3 (15.8%) | 3 (33.3%) | 1 (7.7%) | 0.294 | - | 0.352 | 0.264 | 0.264 |
Others | 3 (15.8%) | 1 (11.1%) | 2 (15.4%) | 0.945 | - | 0.998 | 0.976 | 0.999 |
COVID-19-Related Death (n 180) * | ||
aOR (95CI) | p | |
SARS-CoV-2 Ct | 0.84 (0.72–0.97) | 0.023 |
Age | 1.25 (1.11–1.40) | <0.01 |
Sex | 1.26 (0.21–7.55) | 0.80 |
Time from COVID-19 onset to diagnostic swab | 1.03 (0.91–1.18) | 0.63 |
Number of comorbidities | 2.44 (1.18–5.04) | 0.016 |
Worst oxygen support None Low-flow wall oxygen-reservoir CPAP Intubation | – 2.01 (0.14–8.98) 2.14 (0.65–7.01) 2.38 (0.94–6.06) | - 0.61 0.34 0.068 |
COVID-19 Severity (n 180) * | ||
aOR (95CI) | p | |
SARS-CoV-2 Ct | 0.95 (0.91–0.99) | 0.023 |
Age | 1.08 (1.06–1.11) | <0.01 |
Sex | 0.31 (0.17–0.58) | <0.01 |
Time from COVID-19 onset to diagnostic swab | 1.04 (0.98–1.11) | 0.21 |
Number of comorbidities | 1.6 (1.29–2.03) | <0.01 |
Number of signs and symptoms at diagnosis (n 180) * | ||
β (95CI) | p | |
SARS-CoV-2 Ct | −0.060 (−0.10; −0.018) | <0.01 |
Age | −0.013 (−0.32; 0.006) | 0.17 |
Sex | −0.12 (−0.69; 0.44) | 0.67 |
Number of comorbidities | 0.24 (−0.013; 0.50) | 0.063 |
Time from COVID-19 onset to diagnostic swab | −0.12 (−0.62; 0.51) | 0.99 |
6-month sequelae in survivors (n 149) * | ||
aOR (95CI) | p | |
SARS-CoV-2 Ct | 0.90 (0.85–0.96) | <0.01 |
Age | 1.02 (0.98–1.04) | 0.30 |
Sex | 0.59 (0.26–1.35) | 0.21 |
Time from COVID-19 onset to diagnostic swab | 0.98 (0.89–1.07) | 0.63 |
Number of comorbidities | 1.01 (0.68–1.48) | 0.97 |
Worst oxygen support None Low-flow wall oxygen-reservoir CPAP Intubation | – 1.02 (0.37–2.82) 1.27 (0.37–4.38) 1.72 (0.41–7.29) | - 0.97 0.71 0.46 |
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Trunfio, M.; Venuti, F.; Alladio, F.; Longo, B.M.; Burdino, E.; Cerutti, F.; Ghisetti, V.; Bertucci, R.; Picco, C.; Bonora, S.; et al. Diagnostic SARS-CoV-2 Cycle Threshold Value Predicts Disease Severity, Survival, and Six-Month Sequelae in COVID-19 Symptomatic Patients. Viruses 2021, 13, 281. https://doi.org/10.3390/v13020281
Trunfio M, Venuti F, Alladio F, Longo BM, Burdino E, Cerutti F, Ghisetti V, Bertucci R, Picco C, Bonora S, et al. Diagnostic SARS-CoV-2 Cycle Threshold Value Predicts Disease Severity, Survival, and Six-Month Sequelae in COVID-19 Symptomatic Patients. Viruses. 2021; 13(2):281. https://doi.org/10.3390/v13020281
Chicago/Turabian StyleTrunfio, Mattia, Francesco Venuti, Francesca Alladio, Bianca Maria Longo, Elisa Burdino, Francesco Cerutti, Valeria Ghisetti, Roberto Bertucci, Carlo Picco, Stefano Bonora, and et al. 2021. "Diagnostic SARS-CoV-2 Cycle Threshold Value Predicts Disease Severity, Survival, and Six-Month Sequelae in COVID-19 Symptomatic Patients" Viruses 13, no. 2: 281. https://doi.org/10.3390/v13020281