A descriptive cross-sectional study on Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) cycle threshold level, mortality and pediatric acute respiratory distress syndrome among covid-19 patients admitted at PCMC.

Cristan  Q. Cabanilla,; Iris-Jane  V. Galiza-Arevalo,

A descriptive cross-sectional study on Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) cycle threshold level, mortality and pediatric acute respiratory distress syndrome among covid-19 patients admitted at PCMC.

Iris-Jane V Galiza-Arevalo | Cristan Q. Cabanilla

Abstract:

Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is a novel pathogen that has rapidly caused a devastating pandemic of Coronavirus disease 2019 (COVID-19). The real time reverse transcriptase polymerase chain reaction cycle threshold values are inversely related to viral load and believed to have a role in terms of mortality and severity of the disease however, there is limited data in children. OBJECTIVES: This study aims to determine the RT-PCR cycle threshold level in relation to mortality and pediatric acute respiratory distress syndrome (pARDS) among COVID-19 patients admitted at Philippine Children’s Medical Center. METHODS: A cross sectional study was done on patients with RT-PCR confirmed covid-19 admitted at Philippine Children’s Medical Center from September 2020 to June 2021. RESULTS: 50 nasopharyngeal swab specimens from children admitted for COVID-19 were analyzed. 12 (24%) had acute respiratory distress syndrome. Among the 12 children who had pARDS, six (50%) expired; in those without pARDS, two (5.26%) expired. There was no difference in cycle threshold values between patients who died and who survived, as well as those with or without pARDS. CONCLUSIONS AND RECOMMENDATIONS: We have no evidence to demonstrate a difference in Ct values alone between children who died or survived, or those who developed pARDS or those who did not. RT-PCR cycle threshold alone cannot predict mortality and development of pARDS, it can only indicate the presence of infection but not its severity. Cycle threshold and its significance may further be explored with a bigger population size in children in future studies.

References:

Tang Y-W, Schmitz JE, Persing DH, Stratton CW. Laboratory diagnosis of COVID-19: current issues and Challenges. J Clin Microbiol. 2020;58 (6):e00512-e520.
Infectious Diseases Society of America. IDSA and AMP joint statement on the use of SARS‐CoV‐2 PCR cycle threshold (Ct) values for clinical decision‐making. 2021 March.
Camargo JF, Lin RY, Komanduri KV. Lack of correlation between the SARS-CoV-2 cycle threshold (Ct ) value and clinical outcomes in patients with COVID-19. J Med Virol. 2021 Oct;93(10):6059-6062.
He X, Lau EHY, Wu P, et al. Temporal dynamics in viral shedding and transmissibility of COVID‐19. Nat Med. 2020;26(5):672‐675.
To KK, Tsang OT, Leung WS, 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 Dis. 2020;20(5):565‐574.
Lee S, Kim T, Lee E, et al. Clinical course and molecular viral shedding among asymptomatic and symptomatic patients with SARS‐CoV‐2 in- fection in a Community Treatment Center in the Republic of Korea. JAMA Intern Med. 2020;180(11):1447‐1452.
Ra SH, Lim JS, Kim GU, Kim MJ, et.al. Upper respiratory viral load in asymptomatic individuals and mildly symptomatic patients with SARS‐CoV‐2 infection. Thorax. 2021;76(1):61‐63.
Louie JK, Stoltey JE, Scott HM, et al. Comparison of symptomatic and asymptomatic infections due to severe acute respiratory coronavirus virus 2 (SARS‐CoV‐2) in San Francisco long‐term care facilities. Infect Control Hosp Epidemiol. 2020:1‐3.
Magleby R, Westblade LF, Trzebucki A, et al. Impact of SARS‐CoV‐2 viral load on risk of intubation and mortality among hospitalized patients with coronavirus disease 2019. Clin Infect Dis. 2020.
Westblade LF, Brar G, Pinheiro LC, 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):661‐671.
Choudhuri J, Carter J et al. SARS-CoV-2 PCR cycle threshold at hospital admission associated with patient mortality. PLOS ONE. December 31, 2020.
De la Calle, C., Lalueza, A., Mancheño-Losa, M. 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 40, 1209–1216 (2021)
Huang, J.T.; Ran, R.X.; Lv, Z.H et al. Chronological Changes of Viral Shedding in Adult Inpatients with COVID-19 in Wuhan, China. Clin. Infect. Dis. 2020, 71, 2158–2166.
Chu, C.M.; Poon, L.L.M.; Cheng, V.C.C. et al. Initial viral load and the outcomes of SARS. Cmaj 2004, 171, 1349–1352.
Pan, Y.; Zhang, D.; Yang, P. et. al. Viral load of SARS-CoV-2 in clinical samples. Lancet Infect. Dis. 2020, 20, 411–412.
Rabaan AA, Tirupathi R, Sule AA, et al. Viral Dynamics and Real-Time RT-PCR Ct Values Correlation with Disease Severity in COVID-19. Diagnostics (Basel). 2021 Jun 15;11(6):1091.
Ade C, Pum J, Abele I. et. al.. Analysis of cycle threshold values in SARS-CoV-2-PCR in a long-term study. J Clin Virol. 2021;138:104791.
World Health Organization Clinical Management of COVID -19 Interim Guidance. May 2020.