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Is There a Correlation Between the Cycle Threshold of SARS-CoV-2 RT-PCR and the Clinical Course of COVID-19?

Year 2022, Volume: 75 Issue: 2, 219 - 225, 30.06.2022

Abstract

Objectives: Many parameters are studied in coronavirus disease-2019 (COVID-19) to predict the progress of the disease. One of these parameters is
the clinical significance of the reverse transcriptase-polymerase chain reaction (RT-PCR) cycle threshold (CT) value used in diagnostic tests. In this
study, we evaluated the relationship between RT-PCR CT values and the clinical course of COVID-19.

Materials and Methods: Symptomatic patients over the age of 18 years, who had positive severe acute respiratory syndrome-coronavirus-2 RT-PCR
test results between June 1, 2020 and December 1, 2020, were screened retrospectively. Patients’ CT values and other data were collected from the
hospital’s information management system.

Results: The study included the data of 880 patients. The median age was 63 years, and 47% (415) were female. The severity of COVID-19 was mild
in 69.7% (614), moderate in 20.4% (180), and severe/critical in 9.7% (86). There was no significant difference between median CT (mCT) levels of
disease severity (mCT=22 in mild group; mCT=23 in moderate group; mCT=22 in severe/critical group, p=0.882). The results showed no correlation
between these CT values and COVID-19’s severity, prognosis, or laboratory values.

Conclusion: Although there are some reports that propose a relationship between CT values and viral load, we believe that these test results cannot
be considered quantitative and cannot be generalized because of the many factors known to affect CT values.

Ethical Statement

Ethics Committee Approval: This study was approved by the Başkent University Institutional Review Board (project no: KA20/145, date: 12.01.2021). Informed Consent: Retrospective study. Peer-reviewed: Externally peer-reviewed.

Supporting Institution

-

Project Number

-

Thanks

-

References

  • 1. Izcovich A, Ragusa MA, Tortosa F, et al. Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PLoS One. 2020;15:e0241955.
  • 2. Tom MR, Mina MJ. To Interpret the SARS-CoV-2 Test, Consider the Cycle Threshold Value. Clin Infect Dis. 2020;71:2252-2254.
  • 3. Joynt GM, Wu WK. Understanding COVID-19: what does viral RNA load really mean? Lancet Infect Dis. 2020;20:635-636.
  • 4. Geddes L. Puzzle over viral load. New Sci. 2020;245:8.
  • 5. World Health Organization. Clinical Management of COVID-19: interim guidance (online). Website https://www.who.int/publications/i/item/ clinical-management-of-COVID-19. (accessed 21 May 2021).
  • 6. T.C. Sağlık Bakanlığı halk sağlığı genel müdürlüğü COVID-19 (SARS-CoV-2 enfeksiyonu) erişkin hasta tedavisi bilimsel danışma kurulu çalışması (online). Website https://covid19.saglik.gov.tr/Eklenti/40719/0/covid-19reh berieriskinhastayonetimivetedavipdf.pdf. (accessed 21 May 2021).
  • 7. BioSpeedy Direct RT-qPCR SARS-CoV-2 package insert, Bioeksen R&D Technologies Ltd Şti, 2020
  • 8. Faíco-Filho KS, Passarelli VC, Bellei N. Is Higher Viral Load in SARS-CoV-2 Associated with Death? Am J Trop Med Hyg. 2020;103:2019-2021.
  • 9. Yu X, Sun S, Shi Y, et al. SARS-CoV-2 viral load in sputum correlates with risk of COVID-19 progression. Crit Care. 2020;24:170.
  • 10.. Liu Y, Yan LM, Wan L, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis. 2020;20:656-657.
  • 11. Argyropoulos KV, Serrano A, Hu J, et al. Association of Initial Viral Load in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Patients with Outcome and Symptoms. Am J Pathol. 2020;190:1881-1887.
  • 12. He X, Lau EHY, Wu P, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. 2020;26:672-675.
  • 13. Aykac K, Cura Yayla BC, Ozsurekci Y, et al. The association of viral load and disease severity in children with COVID-19. J Med Virol. 2021;93:3077- 3083.
  • 14. IDSA and AMP joint statement on the use of SARS-CoV-2 PCR cycle threshold (Ct) values for clinical decision-making (online). Website https:// www.idsociety.org/globalassets/idsa/public-health/covid-19/idsa-ampstatement. pdf (accessed 06 May 2021).
  • 15. Rhoads D, Peaper DR, She RC, et al. College of American Pathologists (CAP) Microbiology Committee Perspective: Caution Must Be Used in Interpreting the Cycle Threshold (Ct) Value. Clin Infect Dis. 2021;72:685-686.
  • 16. Huang JT, Ran RX, Lv ZH, et al. Chronological Changes of Viral Shedding in Adult Inpatients With COVID-19 in Wuhan, China. Clin Infect Dis. 2020;71:2158-2166.
  • 17. Wikramaratna PS, Paton RS, Ghafari M, et al. Estimating the false-negative test probability of SARS-CoV-2 by RT-PCR. Euro Surveill. 2020;25:2000568.
  • 18. Yu F, Yan L, Wang N, et al. Quantitative Detection and Viral Load Analysis of SARS-CoV-2 in Infected Patients. Clin Infect Dis. 2020;71:793-798.

SARS-CoV-2 RT-PCR’nin Döngü Eşiği ile COVID-19’un Klinik Seyri Arasında Bir Korelasyon Var mıdır?

Year 2022, Volume: 75 Issue: 2, 219 - 225, 30.06.2022

Abstract

Amaç: Hastalığın progresyonunu tahmin etmek için koronavirüs hastalığı-2019’da (COVID-19) birçok parametre incelenmektedir. Bu parametrelerden
biri, tanısal testlerde kullanılan ters transkriptaz-polimeraz zincir reaksiyonu (RT-PCR) döngü eşiği (CT) değerinin klinik önemidir. Bu çalışmada RTPCR
CT değerleri ile COVID-19’un klinik seyri arasındaki ilişkiyi değerlendirdik.

Gereç ve Yöntem: 1 Haziran 2020 ile 1 Aralık 2020 tarihleri arasında şiddetli akut solunum sendromu-koronavirüs-2 RT-PCR testi pozitif çıkan 18
yaş üstü ve semptomatik hastalar geriye dönük olarak tarandı. Hastaların CT değerleri ve diğer verileri hastanenin bilgi yönetim sisteminden toplandı.

Bulgular: Çalışmaya 880 hastanın verileri dahil edildi. Hastaların yaş ortancası 63 idi ve %47’si (415) kadındı. COVID-19 hastalığının şiddeti hastaların
%69,7’sinde (614) hafif, %20,4’ünde (180) orta ve %9,7’sinde (86) şiddetli/kritik idi. Medyan CT (mCT) değerleri ile hastalık şiddeti arasında anlamlı
bir fark yoktu (hafif hastalık grubunda mCT=22; orta hastalık grubunda mCT=23; şiddetli/kritik hastalık grubunda mCT=22, p=0,882). Çalışmamızın
sonuçları, CT değerleri ile COVID-19’un şiddeti, prognozu veya laboratuvar değerleri arasında bir ilişki olmadığını gösterdi.

Sonuç: Pratikte CT değerleri ile viral yük arasında göreceli bir ilişki olmasına rağmen, CT değerlerini etkilediği bilinen birçok analitik ve klinik faktör
nedeniyle bu test sonuçlarının nicel olarak kabul edilemeyeceğine ve genellenemeyeceğine inanmaktayız.

Ethical Statement

Ethics Committee Approval: This study was approved by the Başkent University Institutional Review Board (project no: KA20/145, date: 12.01.2021). Informed Consent: Retrospective study. Peer-reviewed: Externally peer-reviewed.

Supporting Institution

-

Project Number

-

Thanks

-

References

  • 1. Izcovich A, Ragusa MA, Tortosa F, et al. Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PLoS One. 2020;15:e0241955.
  • 2. Tom MR, Mina MJ. To Interpret the SARS-CoV-2 Test, Consider the Cycle Threshold Value. Clin Infect Dis. 2020;71:2252-2254.
  • 3. Joynt GM, Wu WK. Understanding COVID-19: what does viral RNA load really mean? Lancet Infect Dis. 2020;20:635-636.
  • 4. Geddes L. Puzzle over viral load. New Sci. 2020;245:8.
  • 5. World Health Organization. Clinical Management of COVID-19: interim guidance (online). Website https://www.who.int/publications/i/item/ clinical-management-of-COVID-19. (accessed 21 May 2021).
  • 6. T.C. Sağlık Bakanlığı halk sağlığı genel müdürlüğü COVID-19 (SARS-CoV-2 enfeksiyonu) erişkin hasta tedavisi bilimsel danışma kurulu çalışması (online). Website https://covid19.saglik.gov.tr/Eklenti/40719/0/covid-19reh berieriskinhastayonetimivetedavipdf.pdf. (accessed 21 May 2021).
  • 7. BioSpeedy Direct RT-qPCR SARS-CoV-2 package insert, Bioeksen R&D Technologies Ltd Şti, 2020
  • 8. Faíco-Filho KS, Passarelli VC, Bellei N. Is Higher Viral Load in SARS-CoV-2 Associated with Death? Am J Trop Med Hyg. 2020;103:2019-2021.
  • 9. Yu X, Sun S, Shi Y, et al. SARS-CoV-2 viral load in sputum correlates with risk of COVID-19 progression. Crit Care. 2020;24:170.
  • 10.. Liu Y, Yan LM, Wan L, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis. 2020;20:656-657.
  • 11. Argyropoulos KV, Serrano A, Hu J, et al. Association of Initial Viral Load in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Patients with Outcome and Symptoms. Am J Pathol. 2020;190:1881-1887.
  • 12. He X, Lau EHY, Wu P, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. 2020;26:672-675.
  • 13. Aykac K, Cura Yayla BC, Ozsurekci Y, et al. The association of viral load and disease severity in children with COVID-19. J Med Virol. 2021;93:3077- 3083.
  • 14. IDSA and AMP joint statement on the use of SARS-CoV-2 PCR cycle threshold (Ct) values for clinical decision-making (online). Website https:// www.idsociety.org/globalassets/idsa/public-health/covid-19/idsa-ampstatement. pdf (accessed 06 May 2021).
  • 15. Rhoads D, Peaper DR, She RC, et al. College of American Pathologists (CAP) Microbiology Committee Perspective: Caution Must Be Used in Interpreting the Cycle Threshold (Ct) Value. Clin Infect Dis. 2021;72:685-686.
  • 16. Huang JT, Ran RX, Lv ZH, et al. Chronological Changes of Viral Shedding in Adult Inpatients With COVID-19 in Wuhan, China. Clin Infect Dis. 2020;71:2158-2166.
  • 17. Wikramaratna PS, Paton RS, Ghafari M, et al. Estimating the false-negative test probability of SARS-CoV-2 by RT-PCR. Euro Surveill. 2020;25:2000568.
  • 18. Yu F, Yan L, Wang N, et al. Quantitative Detection and Viral Load Analysis of SARS-CoV-2 in Infected Patients. Clin Infect Dis. 2020;71:793-798.
There are 18 citations in total.

Details

Primary Language English
Subjects Infectious Diseases
Journal Section Articles
Authors

Tuğba Yanık Yalçın 0000-0001-5996-8639

Project Number -
Publication Date June 30, 2022
Published in Issue Year 2022 Volume: 75 Issue: 2

Cite

APA Yanık Yalçın, T. (2022). Is There a Correlation Between the Cycle Threshold of SARS-CoV-2 RT-PCR and the Clinical Course of COVID-19? Ankara Üniversitesi Tıp Fakültesi Mecmuası, 75(2), 219-225. https://doi.org/10.4274/atfm.galenos.2022.97658
AMA Yanık Yalçın T. Is There a Correlation Between the Cycle Threshold of SARS-CoV-2 RT-PCR and the Clinical Course of COVID-19? Ankara Üniversitesi Tıp Fakültesi Mecmuası. June 2022;75(2):219-225. doi:10.4274/atfm.galenos.2022.97658
Chicago Yanık Yalçın, Tuğba. “Is There a Correlation Between the Cycle Threshold of SARS-CoV-2 RT-PCR and the Clinical Course of COVID-19?”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75, no. 2 (June 2022): 219-25. https://doi.org/10.4274/atfm.galenos.2022.97658.
EndNote Yanık Yalçın T (June 1, 2022) Is There a Correlation Between the Cycle Threshold of SARS-CoV-2 RT-PCR and the Clinical Course of COVID-19? Ankara Üniversitesi Tıp Fakültesi Mecmuası 75 2 219–225.
IEEE T. Yanık Yalçın, “Is There a Correlation Between the Cycle Threshold of SARS-CoV-2 RT-PCR and the Clinical Course of COVID-19?”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 75, no. 2, pp. 219–225, 2022, doi: 10.4274/atfm.galenos.2022.97658.
ISNAD Yanık Yalçın, Tuğba. “Is There a Correlation Between the Cycle Threshold of SARS-CoV-2 RT-PCR and the Clinical Course of COVID-19?”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75/2 (June2022), 219-225. https://doi.org/10.4274/atfm.galenos.2022.97658.
JAMA Yanık Yalçın T. Is There a Correlation Between the Cycle Threshold of SARS-CoV-2 RT-PCR and the Clinical Course of COVID-19? Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2022;75:219–225.
MLA Yanık Yalçın, Tuğba. “Is There a Correlation Between the Cycle Threshold of SARS-CoV-2 RT-PCR and the Clinical Course of COVID-19?”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 75, no. 2, 2022, pp. 219-25, doi:10.4274/atfm.galenos.2022.97658.
Vancouver Yanık Yalçın T. Is There a Correlation Between the Cycle Threshold of SARS-CoV-2 RT-PCR and the Clinical Course of COVID-19? Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2022;75(2):219-25.