Using COVID‐19 cycle threshold and other lab values as predictors of hospitalization need

SARS‐COV‐2 (COVID‐19) is a novel virus that has caused over 28 million cases worldwide and over 900,000 deaths since early 2020, rightfully being classified as a pandemic. COVID‐19 is diagnosed via polymerase chain reaction testing which looks at cycle threshold (CT) values of two genes, N2 and E. T...

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Bibliographic Details
Published in:Journal of Medical Virology 2021-05, Vol.93 (5), p.3007-3014
Main Authors: Seeni, Ramamahesh, Firzli, Tarek, Riddle, Mark S., Krasner, Charles, Ashraf, Sara, Siddiqui, Faisal
Format: Article
Language:English
Subjects:
Age
Biomarkers - blood
Cell number
Coronary artery disease
coronavirus
Coronavirus Nucleocapsid Proteins - genetics
COVID-19
COVID-19 - blood
COVID-19 - diagnosis
COVID-19 Nucleic Acid Testing - standards
COVID-19 Nucleic Acid Testing - statistics & numerical data
Dimers
Erythrocyte sedimentation rate
Erythrocytes
Ferritin
Fibrinogen
Heart diseases
Hospitalization - statistics & numerical data
Hospitals, Veterans
Humans
infection
Leukocytes
Lung diseases
Lymphocytes
Models, Statistical
Odds Ratio
pandemic
Pandemics
Phosphoproteins - genetics
Polymerase chain reaction
Predictive Value of Tests
Prognosis
Proteins
replication
Retrospective Studies
SARS-CoV-2 - genetics
SARS-CoV-2 - isolation & purification
Severe acute respiratory syndrome coronavirus 2
Severity of Illness Index
spread
Tomography
Viral diseases
Virology
Viruses
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Summary:SARS‐COV‐2 (COVID‐19) is a novel virus that has caused over 28 million cases worldwide and over 900,000 deaths since early 2020, rightfully being classified as a pandemic. COVID‐19 is diagnosed via polymerase chain reaction testing which looks at cycle threshold (CT) values of two genes, N2 and E. This study examined CT values of COVID‐positive patients at the VA hospital in Reno as well as other lab values and comorbidities to determine if any could aid clinicians in predicting the need for hospitalization and higher levels of care. Multiple variables, including N2 CT value, absolute lymphocyte count (ALC), D‐dimer, erythrocyte sedimentation rate, C‐reactive protein, fibrinogen, and ferritin were evaluated for potential associations with N2 CT value as well as required level of care (based on World Health Organization [WHO] ordinal score). The results suggest that patients with a N2 CT value less than 34 are four times more likely to have WHO ordinal scores of 4–8 (p = .0021) while controlling for age and comorbidities (DM, cardiac, kidney, and lung disease). Patients of age 55 or greater were 15.18 times more likely to have WHO ordinal scores of 4–8 (p = .012) controlling for N2 CT value and comorbidities. Furthermore, patients with ALC less than 1 were 5.88 times more likely to have WHO ordinal score of 4–8 (p = .00024). N2 CT values also appear to be associated with many commonly obtained markers such as ALC, white blood cell count, C‐reactive protein, and D‐dimer. Patients with N2 CT values less than 34 were 3.49 times more likely to have ALC values less than 1, controlling for age and comorbidities (p = .0072) while patients 55 or older were 6.66 times more likely to have ALC less than 1 (p = .027). Finally, this study confirms previous conclusions that patients with advanced age had more severe infections and thus will likely require higher levels of care.
ISSN:0146-6615
1096-9071
DOI:10.1002/jmv.26835