Cycle Threshold Values Predict COVID-19 Severity and Mortality but Are not Correlated with Laboratory Markers
-
Behnaz Esmaeili
,
Hoda Khoshnevis
,
Atefe Alirezaee
,
Abbas Shakoori
,
Zahra Pourpak
,
Hamid Chegini
,
Zahra Ahmadinejad
Abstract
Many studies have evaluated the possible utility of cycle threshold (Ct) values as a predictor of Coronavirus disease 2019 (COVID-19) severity and patient outcome. Given the inconsistent results, we aimed to evaluate the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Ct values and disease severity, inflammatory markers, and outcomes in Iranian patients with COVID-19.
A retrospective study of 528 patients with COVID-19 hospitalized from September 2020 to October 2021 was conducted. Demographic, clinical, and laboratory data of patients were retrieved from electronic medical records. Ct values were analyzed as a continuous variable after subcategorizing into 3 groups: low (Ct values<20), medium (Ct values 20 to 30), and high (Ct values>30).
Of the 528 patients (45.1% female) aged 13 to 97 years, 109 patients had low Ct values, 312 patients had medium, and 107 patients had high Ct values. Patients with low Ct values were more likely to present with critical COVID-19, require invasive mechanical ventilation and develop complications such as acute respiratory distress syndrome and pneumonia. Furthermore, patients with low or medium Ct values were more likely to die compared to patients with high Ct values. Multivariate analysis showed that patients with low or medium Ct values were more likely to have severe COVID-19 compared with patients with high Ct values. The multivariate analysis also showed a higher risk of mortality in patients with low Ct values compared to patients with high Ct values, although this was not statistically significant.
Our findings revealed that Ct values were an independent predictor of COVID-19 severity. The risk of mortality was higher in patients with low Ct values. However, further investigation is needed to address the correlation between Ct values and inflammatory factors.
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2. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.
3. Esmaeili B, Esmaeili S, Pourpak Z. Immunological effects of convalescent plasma therapy for coronavirus: a scoping review. BMC Infect Dis. 2021;21(1):1-10.
4. Alnor A, Sandberg MB, Gils C, Vinholt PJ. Laboratory tests and outcome for patients with coronavirus disease 2019: a systematic review and meta-analysis. The journal of applied laboratory medicine. 2020;5(5):1038-49.
5. Gao Y, Li T, Han M, Li X, Wu D, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID‐19. J Med Virol. 2020;92(7):791-6.
6. Leulseged TW, Hassen IS, Ayele BT, Tsegay YG, Abebe DS, Edo MG, et al. Laboratory biomarkers of COVID-19 disease severity and outcome: Findings from a developing country. Plos one. 2021;16(3):e0246087.
7. Patel A, Jernigan DB. Initial public health response and interim clinical guidance for the 2019 novel coronavirus outbreak—United States, December 31, 2019–February 4, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(5):140.
8. Tom MR, Mina MJ. To interpret the SARS-CoV-2
test, consider the cycle threshold value. Clin Infect Dis. 2020.
9. Pujadas E, Chaudhry F, McBride R, Richter F, Zhao
S, Wajnberg A, et al. SARS-CoV-2 viral load predicts COVID-19 mortality. Lancet Respir Med. 2020;8(9):e70.
10. Huang J-T, Ran R-X, Lv Z-H, Feng L-N, Ran C-Y, Tong Y-Q, et al. Chronological changes of viral shedding in adult inpatients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020;71(16):2158-66.
11. Singanayagam A, Patel M, Charlett A, Bernal JL, Saliba V, Ellis J, et al. Duration of infectiousness and correlation with RT-PCR cycle threshold values in cases of COVID-19, England, January to May 2020. Euro Surveill. 2020;25(32):2001483.
12. Yu X, Sun S, Shi Y, Wang H, Zhao R, Sheng J. SARS-CoV-2 viral load in sputum correlates with risk of COVID-19 progression. Critical Care. 2020;24(1):1-4.
13. Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63(3):364-74.
14. Walsh KA, Jordan K, Clyne B, Rohde D, Drummond L, Byrne P, et al. SARS-CoV-2 detection, viral load and infectivity over the course of an infection: SARS-CoV-2 detection, viral load and infectivity. J Infect. 2020.
15. Rao SN, Manissero D, Steele VR, Pareja J. A narrative systematic review of the clinical utility of cycle threshold values in the context of COVID-19. Infect Dis Ther. 2020:1-14.
16. Yuan C, Zhu H, Yang Y, Cai X, Xiang F, Wu H, et al. Viral loads in throat and anal swabs in children infected with SARS-CoV-2. Emerg Microbes Infect. 2020;9(1):1233-7.
17. Azzi L, Carcano G, Gianfagna F, Grossi P, Dalla Gasperina D, Genoni A, et al. Saliva is a reliable tool to detect SARS-CoV-2. J Infect. 2020;81(1):e45-e50.
18. Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID‐19) implicate special control measures. J Med Virol. 2020;92(6):568-76.
19. Westblade LF, Brar G, Pinheiro LC, Paidoussis D, Rajan M, Martin P, et al. SARS-CoV-2 viral load predicts mortality in patients with and without cancer who are hospitalized with COVID-19. Cancer Cell. 2020;38(5):661-71. e2.
20. Waudby-West R, Parcell BJ, Palmer CN, Bell S, Chalmers JD, Siddiqui MK. The association between SARS-CoV-2 RT-PCR cycle threshold and mortality in a community cohort. Eur Respir J. 2021;58(1).
21. Liu Y, Yan L-M, Wan L, Xiang T-X, Le A, Liu J-M, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis. 2020;20(6):656-7.
22. Shah VP, Farah WH, Hill JC, Hassett LC, Binnicker MJ, Yao JD, et al. editors. Association between SARS-CoV-2 cycle threshold values and clinical outcomes in patients with COVID-19: a systematic review and meta-analysis. Open Forum Infect Dis. 2021;8(9):453.
23. Liu Y, Liao W, Wan L, Xiang T, Zhang W. Correlation between relative nasopharyngeal virus RNA load and lymphocyte count disease severity in patients with COVID-19. Viral Immunol. 2021;34(5):330-5.
24. Zheng S, Fan J, Yu F, Feng B, Lou B, Zou Q, 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.
25. Guo X, Jie Y, Ye Y, Chen P, Li X, Gao Z, et al. editors. Upper respiratory tract viral ribonucleic acid load at hospital admission is associated with coronavirus disease 2019 disease severity. Open forum infectious diseases; 2020: Oxford University Press US.
26. Xia X-y, Wu J, Liu H-l, Xia H, Jia B, Huang W-x. Epidemiological and initial clinical characteristics of patients with family aggregation of COVID-19. J Clin Virol. 2020;127:104360.
27. Fukushima T, Kabata H, Yamamoto R, Suhara T, Uwamino Y, Kondo Y, et al. The real-time reverse transcription-polymerase chain reaction threshold cycle values for severe acute respiratory syndrome coronavirus 2 predict the prognosis of coronavirus disease 2019 pneumonia. Respiratory Invest. 2021;59(3):360-3.
28. Schwierzeck V, König JC, Kühn J, Mellmann A, Correa-Martínez CL, Omran H, et al. First reported nosocomial outbreak of severe acute respiratory syndrome coronavirus 2 in a pediatric dialysis unit. Clin Infect Dis. 2021;72(2):265-70.
29. de la Calle C, Lalueza A, Mancheño-Losa M, Maestro-de la Calle G, Lora-Tamayo J, Arrieta E, et al. Impact of viral load at admission on the development of respiratory failure in hospitalized patients with SARS-CoV-2 infection. Eur J Clin Microbiol Infect Dis. 2021;40(6):1209-16.
30. Abdulrahman A, Mallah S, AlQahtani M. COVID-19 Viral Load Not Associated with Disease Severity: Findings from A Retrospective Cohort Study. 2021.
31. Asai N, Sakanashi D, Ohashi W, Nakamura A, Yamada A, Kawamoto Y, et al. Could threshold cycle value correctly reflect the severity of novel coronavirus disease 2019 (COVID-19)? J Infect Chemother. 2021;27(1):117-9.
32. He X, Lau EH, Wu P, Deng X, Wang J, Hao X, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. 2020;26(5):672-5.
33. Shah S, Singhal T, Davar N, Thakkar P. No correlation between Ct values and severity of disease or mortality in patients with COVID 19 disease. Indian J Med Microbiol. 2021;39(1):116-7.
34. Arons MM, Hatfield KM, Reddy SC, Kimball A, James A, Jacobs JR, et al. Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility. New Eng J Med. 2020;382(22):2081-90.
35. Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. New Eng J Med. 2020;382(12):1177-9.
36. Lee S, Kim T, Lee E, Lee C, Kim H, Rhee H, et al. Clinical course and molecular viral shedding among asymptomatic and symptomatic patients with SARS-CoV-2 infection in a community treatment center in the Republic of Korea. JAMA. 2020;180(11):1447-52.
37. 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(5):2019.
38. Gaston DC, Malinis M, Osborn R, Peaper DR, Landry M, Juthani‐Mehta M, et al. Clinical implications of SARS‐CoV‐2 cycle threshold values in solid organ transplant recipients. Am J Transplantation. 2021;21(3):1304-11.
39. Yagci AK, Sarinoglu RC, Bilgin H, Yanılmaz Ö, Sayın E, Deniz G, et al. Relationship of the cycle threshold values of SARS-CoV-2 polymerase chain reaction and total severity score of computerized tomography in patients with COVID 19. Int J Infect Dis. 2020;101:160-6.
40. Machado A, Salvador P, Oliveira P, Teixeira T, Figueiredo C, Nunes S, et al. The impact of SARS-CoV-2 viral load on the mortality of hospitalized patients: a retrospective analysis. Cureus. 2021;13(7).
41. Maltezou HC, Raftopoulos V, Vorou R, Papadima K, Mellou K, Spanakis N, et al. Association between upper respiratory tract viral load, comorbidities, disease severity, and outcome of patients with SARS-CoV-2 infection. J infect Dis. 2021;223(7):1132-8.
42. Choudhuri J, Carter J, Nelson R, Skalina K, Osterbur-Badhey M, Johnston A, et al. SARS-CoV-2 PCR cycle threshold at hospital admission associated with patient mortality. PloS one. 2020;15(12):e0244777.
43. Sadeghi F, Pournajaf A, Halaji M, Chehrazi M, Amiri FH, Amoli SS, et al. A Large Retrospective Study of Epidemiological Characteristics of COVID-19 Patients in the North of Iran: Association between SARS-CoV-2 RT-PCR Ct Values with Demographic Data. Int J Clin Practice. 2022;2022.
44. Magleby R, Westblade LF, Trzebucki A, Simon MS, Rajan M, Park J, et al. Impact of SARS-CoV-2 viral load on risk of intubation and mortality among hospitalized patients with coronavirus disease 2019. Clin Infecti Dis. 2020.
45. Bryan A, Fink SL, Gattuso MA, Pepper G, Chaudhary A, Wener MH, et al., editors. SARS-CoV-2 viral load on admission is associated with 30-day mortality. Open forum infectious diseases; 2020: Oxford University Press US.
46. Seeni R, Firzli T, Riddle MS, Krasner C, Ashraf S, Siddiqui F. Using COVID‐19 cycle threshold and other lab values as predictors of hospitalization need. J Med Virol. 2021;93(5):3007-14.
47. To KK-W, Tsang OT-Y, Leung W-S, Tam AR, Wu T-C, Lung DC, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Diss. 2020;20(5):565-74.
48. Shi F, Wu T, Zhu X, Ge Y, Zeng X, Chi Y, et al. Association of viral load with serum biomakers among COVID-19 cases. Virology. 2020;546:122-6.
49. Ade C, Pum J, Abele I, Raggub L, Bockmühl D, Zöllner B. Analysis of cycle threshold values in SARS-CoV-2-PCR in a long-term study. J Clinl Virol. 2021;138:104791.
50. Zhao Y, Cunningham MH, Mediavilla JR, Park S, Fitzgerald S, Ahn HS, et al. Diagnosis, clinical characteristics, and outcomes of COVID-19 patients from a large healthcare system in northern New Jersey. Sci Reports. 2021;11(1):1-8.
51. Huang H, Cai S, Li Y, Li Y, Fan Y, Li L, et al. Prognostic factors for covid-19 pneumonia progression to severe symptoms based on earlier clinical features: A retrospective analysis. Front Med. 2020;7:643.
52. Ramirez‐Hinojosa JP, Rodriguez‐Sanchez Y, Romero‐Gonzalez AK, Chavez‐Gutierrez M, Gonzalez‐Arenas NR, Ibarra‐Arce A, et al. Association between cycle threshold (Ct) values and clinical and laboratory data in inpatients with COVID‐19 and asymptomatic health workers. J Med Virol. 2021;93(10):5969-76.
2. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.
3. Esmaeili B, Esmaeili S, Pourpak Z. Immunological effects of convalescent plasma therapy for coronavirus: a scoping review. BMC Infect Dis. 2021;21(1):1-10.
4. Alnor A, Sandberg MB, Gils C, Vinholt PJ. Laboratory tests and outcome for patients with coronavirus disease 2019: a systematic review and meta-analysis. The journal of applied laboratory medicine. 2020;5(5):1038-49.
5. Gao Y, Li T, Han M, Li X, Wu D, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID‐19. J Med Virol. 2020;92(7):791-6.
6. Leulseged TW, Hassen IS, Ayele BT, Tsegay YG, Abebe DS, Edo MG, et al. Laboratory biomarkers of COVID-19 disease severity and outcome: Findings from a developing country. Plos one. 2021;16(3):e0246087.
7. Patel A, Jernigan DB. Initial public health response and interim clinical guidance for the 2019 novel coronavirus outbreak—United States, December 31, 2019–February 4, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(5):140.
8. Tom MR, Mina MJ. To interpret the SARS-CoV-2
test, consider the cycle threshold value. Clin Infect Dis. 2020.
9. Pujadas E, Chaudhry F, McBride R, Richter F, Zhao
S, Wajnberg A, et al. SARS-CoV-2 viral load predicts COVID-19 mortality. Lancet Respir Med. 2020;8(9):e70.
10. Huang J-T, Ran R-X, Lv Z-H, Feng L-N, Ran C-Y, Tong Y-Q, et al. Chronological changes of viral shedding in adult inpatients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020;71(16):2158-66.
11. Singanayagam A, Patel M, Charlett A, Bernal JL, Saliba V, Ellis J, et al. Duration of infectiousness and correlation with RT-PCR cycle threshold values in cases of COVID-19, England, January to May 2020. Euro Surveill. 2020;25(32):2001483.
12. Yu X, Sun S, Shi Y, Wang H, Zhao R, Sheng J. SARS-CoV-2 viral load in sputum correlates with risk of COVID-19 progression. Critical Care. 2020;24(1):1-4.
13. Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63(3):364-74.
14. Walsh KA, Jordan K, Clyne B, Rohde D, Drummond L, Byrne P, et al. SARS-CoV-2 detection, viral load and infectivity over the course of an infection: SARS-CoV-2 detection, viral load and infectivity. J Infect. 2020.
15. Rao SN, Manissero D, Steele VR, Pareja J. A narrative systematic review of the clinical utility of cycle threshold values in the context of COVID-19. Infect Dis Ther. 2020:1-14.
16. Yuan C, Zhu H, Yang Y, Cai X, Xiang F, Wu H, et al. Viral loads in throat and anal swabs in children infected with SARS-CoV-2. Emerg Microbes Infect. 2020;9(1):1233-7.
17. Azzi L, Carcano G, Gianfagna F, Grossi P, Dalla Gasperina D, Genoni A, et al. Saliva is a reliable tool to detect SARS-CoV-2. J Infect. 2020;81(1):e45-e50.
18. Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID‐19) implicate special control measures. J Med Virol. 2020;92(6):568-76.
19. Westblade LF, Brar G, Pinheiro LC, Paidoussis D, Rajan M, Martin P, et al. SARS-CoV-2 viral load predicts mortality in patients with and without cancer who are hospitalized with COVID-19. Cancer Cell. 2020;38(5):661-71. e2.
20. Waudby-West R, Parcell BJ, Palmer CN, Bell S, Chalmers JD, Siddiqui MK. The association between SARS-CoV-2 RT-PCR cycle threshold and mortality in a community cohort. Eur Respir J. 2021;58(1).
21. Liu Y, Yan L-M, Wan L, Xiang T-X, Le A, Liu J-M, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis. 2020;20(6):656-7.
22. Shah VP, Farah WH, Hill JC, Hassett LC, Binnicker MJ, Yao JD, et al. editors. Association between SARS-CoV-2 cycle threshold values and clinical outcomes in patients with COVID-19: a systematic review and meta-analysis. Open Forum Infect Dis. 2021;8(9):453.
23. Liu Y, Liao W, Wan L, Xiang T, Zhang W. Correlation between relative nasopharyngeal virus RNA load and lymphocyte count disease severity in patients with COVID-19. Viral Immunol. 2021;34(5):330-5.
24. Zheng S, Fan J, Yu F, Feng B, Lou B, Zou Q, 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.
25. Guo X, Jie Y, Ye Y, Chen P, Li X, Gao Z, et al. editors. Upper respiratory tract viral ribonucleic acid load at hospital admission is associated with coronavirus disease 2019 disease severity. Open forum infectious diseases; 2020: Oxford University Press US.
26. Xia X-y, Wu J, Liu H-l, Xia H, Jia B, Huang W-x. Epidemiological and initial clinical characteristics of patients with family aggregation of COVID-19. J Clin Virol. 2020;127:104360.
27. Fukushima T, Kabata H, Yamamoto R, Suhara T, Uwamino Y, Kondo Y, et al. The real-time reverse transcription-polymerase chain reaction threshold cycle values for severe acute respiratory syndrome coronavirus 2 predict the prognosis of coronavirus disease 2019 pneumonia. Respiratory Invest. 2021;59(3):360-3.
28. Schwierzeck V, König JC, Kühn J, Mellmann A, Correa-Martínez CL, Omran H, et al. First reported nosocomial outbreak of severe acute respiratory syndrome coronavirus 2 in a pediatric dialysis unit. Clin Infect Dis. 2021;72(2):265-70.
29. de la Calle C, Lalueza A, Mancheño-Losa M, Maestro-de la Calle G, Lora-Tamayo J, Arrieta E, et al. Impact of viral load at admission on the development of respiratory failure in hospitalized patients with SARS-CoV-2 infection. Eur J Clin Microbiol Infect Dis. 2021;40(6):1209-16.
30. Abdulrahman A, Mallah S, AlQahtani M. COVID-19 Viral Load Not Associated with Disease Severity: Findings from A Retrospective Cohort Study. 2021.
31. Asai N, Sakanashi D, Ohashi W, Nakamura A, Yamada A, Kawamoto Y, et al. Could threshold cycle value correctly reflect the severity of novel coronavirus disease 2019 (COVID-19)? J Infect Chemother. 2021;27(1):117-9.
32. He X, Lau EH, Wu P, Deng X, Wang J, Hao X, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. 2020;26(5):672-5.
33. Shah S, Singhal T, Davar N, Thakkar P. No correlation between Ct values and severity of disease or mortality in patients with COVID 19 disease. Indian J Med Microbiol. 2021;39(1):116-7.
34. Arons MM, Hatfield KM, Reddy SC, Kimball A, James A, Jacobs JR, et al. Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility. New Eng J Med. 2020;382(22):2081-90.
35. Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. New Eng J Med. 2020;382(12):1177-9.
36. Lee S, Kim T, Lee E, Lee C, Kim H, Rhee H, et al. Clinical course and molecular viral shedding among asymptomatic and symptomatic patients with SARS-CoV-2 infection in a community treatment center in the Republic of Korea. JAMA. 2020;180(11):1447-52.
37. 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(5):2019.
38. Gaston DC, Malinis M, Osborn R, Peaper DR, Landry M, Juthani‐Mehta M, et al. Clinical implications of SARS‐CoV‐2 cycle threshold values in solid organ transplant recipients. Am J Transplantation. 2021;21(3):1304-11.
39. Yagci AK, Sarinoglu RC, Bilgin H, Yanılmaz Ö, Sayın E, Deniz G, et al. Relationship of the cycle threshold values of SARS-CoV-2 polymerase chain reaction and total severity score of computerized tomography in patients with COVID 19. Int J Infect Dis. 2020;101:160-6.
40. Machado A, Salvador P, Oliveira P, Teixeira T, Figueiredo C, Nunes S, et al. The impact of SARS-CoV-2 viral load on the mortality of hospitalized patients: a retrospective analysis. Cureus. 2021;13(7).
41. Maltezou HC, Raftopoulos V, Vorou R, Papadima K, Mellou K, Spanakis N, et al. Association between upper respiratory tract viral load, comorbidities, disease severity, and outcome of patients with SARS-CoV-2 infection. J infect Dis. 2021;223(7):1132-8.
42. Choudhuri J, Carter J, Nelson R, Skalina K, Osterbur-Badhey M, Johnston A, et al. SARS-CoV-2 PCR cycle threshold at hospital admission associated with patient mortality. PloS one. 2020;15(12):e0244777.
43. Sadeghi F, Pournajaf A, Halaji M, Chehrazi M, Amiri FH, Amoli SS, et al. A Large Retrospective Study of Epidemiological Characteristics of COVID-19 Patients in the North of Iran: Association between SARS-CoV-2 RT-PCR Ct Values with Demographic Data. Int J Clin Practice. 2022;2022.
44. Magleby R, Westblade LF, Trzebucki A, Simon MS, Rajan M, Park J, et al. Impact of SARS-CoV-2 viral load on risk of intubation and mortality among hospitalized patients with coronavirus disease 2019. Clin Infecti Dis. 2020.
45. Bryan A, Fink SL, Gattuso MA, Pepper G, Chaudhary A, Wener MH, et al., editors. SARS-CoV-2 viral load on admission is associated with 30-day mortality. Open forum infectious diseases; 2020: Oxford University Press US.
46. Seeni R, Firzli T, Riddle MS, Krasner C, Ashraf S, Siddiqui F. Using COVID‐19 cycle threshold and other lab values as predictors of hospitalization need. J Med Virol. 2021;93(5):3007-14.
47. To KK-W, Tsang OT-Y, Leung W-S, Tam AR, Wu T-C, Lung DC, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Diss. 2020;20(5):565-74.
48. Shi F, Wu T, Zhu X, Ge Y, Zeng X, Chi Y, et al. Association of viral load with serum biomakers among COVID-19 cases. Virology. 2020;546:122-6.
49. Ade C, Pum J, Abele I, Raggub L, Bockmühl D, Zöllner B. Analysis of cycle threshold values in SARS-CoV-2-PCR in a long-term study. J Clinl Virol. 2021;138:104791.
50. Zhao Y, Cunningham MH, Mediavilla JR, Park S, Fitzgerald S, Ahn HS, et al. Diagnosis, clinical characteristics, and outcomes of COVID-19 patients from a large healthcare system in northern New Jersey. Sci Reports. 2021;11(1):1-8.
51. Huang H, Cai S, Li Y, Li Y, Fan Y, Li L, et al. Prognostic factors for covid-19 pneumonia progression to severe symptoms based on earlier clinical features: A retrospective analysis. Front Med. 2020;7:643.
52. Ramirez‐Hinojosa JP, Rodriguez‐Sanchez Y, Romero‐Gonzalez AK, Chavez‐Gutierrez M, Gonzalez‐Arenas NR, Ibarra‐Arce A, et al. Association between cycle threshold (Ct) values and clinical and laboratory data in inpatients with COVID‐19 and asymptomatic health workers. J Med Virol. 2021;93(10):5969-76.
| Files | ||
| Issue | Vol 22 No 5 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijaai.v22i5.13996 | |
| Keywords | ||
| COVID19 Cycle threshold Prognosis Viral infections Viral load | ||
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How to Cite
1.
Esmaeili B, Khoshnevis H, Alirezaee A, Shakoori A, Pourpak Z, Chegini H, Ahmadinejad Z. Cycle Threshold Values Predict COVID-19 Severity and Mortality but Are not Correlated with Laboratory Markers. Iran J Allergy Asthma Immunol. 2023;22(5):468-481.
