COVID-19 HASTALARINDA UZAMIŞ RT-PCR POZİTİFLİĞİ VE VİRAL YÜKÜN DEĞERLENDİRİLMESİ

Öz

Amaç: COVID-19 tanısında gerçek-zamanlı polimeraz zincir reaksiyonu (RT-PCR) testi kullanılmakta olup çalışmamızda; viral konversiyon süresini etkileyen faktörlerin ve bunların viral yük ile ilişkisinin incelenmesi, ayrıca viral yükü etkileyebilecek diğer faktörlerin irdelenmesi amaçlanmıştır. Metod: Hastanemizde 15.03.2020-01.08.2020 tarihleri arasında hospitalize edilmiş ve viral konversiyon saptanmış hastalar retrospektif olarak tarandı. Hastalar viral konversiyon süresine göre iki gruba ayrıldı (0-14 gün ve >14 gün). Bulgular: Çalışmaya viral konversiyon süresi 0-14 gün olan 284 hasta ve >14 gün olan 65 hasta olmak üzere toplam 349 hasta dahil edildi. Hastaların yaş ve cinsiyet özellikleri benzer olarak saptandı. Uzamış PCR pozitifliği olan grupta daha fazla ölüm (p=0.036) ve daha düşük döngü eşiği (Cycle-treshold- CT) değeri (p=0.017) saptandı. 18’inde mortalite nedeniyle viral konversiyonun değerlendirilemediği toplam 246 hastanın CT değerinin incelemesinde 60 yaş üzerinde (p=0.006), kardiyovasküler sistem hastalığı varlığında (p<0.001) ve ölen hastalarda (p<0.001) CT değeri daha düşük, dolayısıyla viral yük daha yüksek saptandı. Sonuç: Uzamış PCR pozitifliği viral yük artışını ve olumsuz sonuçlarla ilişkili olabilir. Hastanın yaşı, CT değeri, komorbid durumları ve viral konversiyon süresini içeren bir değerlendirme progroz hakkında fikir verebilir.

Anahtar Kelimeler

• Klerens
• döngü-eşiği (CT) değeri
• negatif konversiyon
• SARS-CoV-2
• viral yük

Evaluation of Prolonged Rt-Pcr Positivity and Viral Load in COVID-19 Patients

Abstract

Aim: Real-time reverse transcription polymerase chain reaction (RT-PCR) test is used in the diagnosis of COVID-19. It was aimed to evaluate the factors affecting the viral conversion time, to examine the relationship between viral load, and to determine other factors that may be associated with viral load. Material and Methods: Patients were hospitalized between 15.03.2020-01.08.2020, and viral conversion detected were evaluated retrospectively. Patients were divided into two according to viral conversion time (0-14 days vs >14 days). Results: 349 patients were included in the study (284 vs 65 patients). The age and gender characteristics were similar. Prolonged PCR positivity group had more death (p=0.036) and lower cycle-threshold (CT) value (p=0.017). In the examination of CT values of 246 patients, 228 patients with viral conversion and 18 patients without viral conversion due to death, the CT value was found to be lower, therefore the viral load was higher in patients over 60 years of age (p=0.006), in the presence of cardiovascular system disease (p<0.001) and in patients who died (p<0.001). Conclusion: Prolonged PCR positivity may indicate excess viral load and adverse outcomes. An evaluation including the patient's age, CT value, comorbid conditions, and viral conversion time can give an idea about the prognosis.

Keywords

• Clearance
• cycle threshold (CT) value
• negative conversion
• SARS‐CoV‐2
• viral load

Kaynakça

1. Referans1. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. New England journal of medicine, 2020; 382:727-733. http://doi.org/10.1056/NEJMoa2001017
2. Referans2. World Health Organization. Director-General’s opening remarks at the media briefing on COVID-19- 11 March 2020, https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020. (Accessed on 20 December 2021)
3. Referans3. World Health Organization. Laboratory testing for 2019 novel coronavirus (2019-nCoV)in suspected human cases. Interim guidance. Jan 17, 2020. https://www.who.int/publications/i/item/10665-331501. (Accessed on 20 December 2021)
4. Referans4. Praharaj I, Jain A, Singh M, et al. Pooled testing for COVID-19 diagnosis by real-time RT-PCR: A multi-site comparative evaluation of 5-& 10-sample pooling. The Indian journal of medical research, 2020; 152(1-2), 88. https://doi.org/10.4103/ijmr.IJMR_2304_20
5. Referans5. Bustin SA, Mueller R. Real-time reverse transcription PCR (qRT-PCR) and its potential use in clinical diagnosis. Clinical Science (Lond), 2005;109(4), 365-379. https://doi.org/10.1042/CS20050086
6. Referans6. Zheng S, Fan J, Yu F, et al. Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study. bmj, 2020; 369. https://doi.org/10.1136/bmj.m1443
7. Referans7. Liu R, Yi S, Zhang J, et al. Viral Load Dynamics in Sputum and Nasopharyngeal Swab in Patients with COVID-19. Journal of dental research, 2020; 99(11), 1239-1244. https://doi.org/10.1177/0022034520946251
8. Referans8. Bhattacharya B, Kumar R, Meena VP, et al. SARS-CoV-2 RT-PCR profile in 298 Indian COVID-19 patients: a retrospective observational study. Pathogens and disease, 2021; 79(1), ftaa064. https://doi.org/10.1093/femspd/ftaa064

9. Referans9. Prokop M, Van Everdingen W, Van Rees Vellinga T, et al. COVID-19 Standardized Reporting Working Group of the Dutch Radiological Society. CO-RADS: a categorical CT assessment scheme for patients suspected of having COVID-19—definition and evaluation. Radiology, 2020; 296(2), E97-E104. https://doi.org/10.1148/radiol.2020201473
10. Referans10. Hu X, Xing Y, Jia J, et al. Factors associated with negative conversion of viral RNA in patients hospitalized with COVID-19. Science of the Total Environment, 2020; 728, 138812. https://doi.org/10.1016/j.scitotenv.2020.138812
11. Referans11. Howard-Jones AR, Maddocks S, Basile K, et al. Prolonged PCR positivity in elderly patients infected with SARS-CoV-2. Pathology, 2021; 53(7), 914-916. : https://doi.org/10.1016/j.pathol.2021.08.004
12. Referans12. Aranha C, Patel V, Bhor V, Gogoi D. Cycle threshold values in RT‐PCR to determine dynamics of SARS‐CoV‐2 viral load: An approach to reduce the isolation period for COVID‐19 patients. Journal of Medical Virology, 2021; 93(12), 6794-6797. https://doi.org/10.1002/jmv.27206
13. Referans13. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet, 2020; 395(10223), 497-506. https://doi.org/10.1016/S0140-6736(20)30183-5
14. Referans14. Sarinoglu RC, Guneser D, Sengel BE, et al. Evaluation of different respiratory samples and saliva for the detection of SARS-CoV-2 RNA. Marmara Medical Journal, 2021; 34(1), 51-56. http://doi.org/10.5472/marumj.866658
15. Referans15. Liu Y, Yang Y, Zhang C, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Science China Life Sciences, 2020; 63(3), 364-374. https://doi.org/10.1016/S0140-6736(20)30154-9
16. Referans16. Nar R, Caliskan A, Sari T, Akbudak IH, et al. Evaluation of the relationship between viral load and biochemical parameters in Covid-19 patients. Medicine, 2021; 10(2), 469-73. http://doi.org/10.5455/medscience.2020.10.218
17. Referans17. Huang JT, Ran RX, Lv ZH, et al. Chronological changes of viral shedding in adult inpatients with COVID-19 in Wuhan, China. Clinical Infectious Diseases, 2020; 71(16), 2158-2166. https://doi.org/10.1093/cid/ciaa631
18. Referans18. Liu Y, Liao W, Wan L, et al. Correlation between relative nasopharyngeal virus RNA load and lymphocyte count disease severity in patients with COVID-19. Viral immunology, 2021; 34(5), 330-335. https://doi.org/10.1089/vim.2020.0062
19. Referans19. Abus S., Kapici OB. Investigation of Clinical and Sociodemographic Characteristics of Critically Patients with COVID-19 Admitted to Intensive Care Unit. Medical Records, 4(2), 141-7. http:/doi.org/10.37990/medr.1019109
20. Referans20. Yu X, Sun S, Shi Y, et al. SARS-CoV-2 viral load in sputum correlates with risk of COVID-19 progression. Critical care, 2020; 24(1), 1-4. https://doi.org/10.1186/s13054-020-02893-8
21. Referans21. Rao SN, Manissero D, Steele VR, Pareja J. A Systematic Review of the Clinical Utility of Cycle Threshold Values in the Context of COVID-19. Infectious Diseases and Therapy, 2020; 9(3), 587-587. https://doi.org/10.1007/s40121-020-00324-3