Pretest Symptom Duration and Cycle Threshold Values for Severe Acute Respiratory Syndrome Coronavirus 2 Reverse-Transcription Polymerase Chain Reaction Predict Coronavirus Disease 2019 Mortality.
Pretest Symptom Duration and Cycle Threshold Values for Severe Acute Respiratory Syndrome Coronavirus 2 Reverse-Transcription Polymerase Chain Reaction Predict Coronavirus Disease 2019 Mortality.
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DOI：
10.1093/ofid/ofab003
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发表时间：
2021-03
影响因子：
4.2
通讯作者：
Uhlemann AC
中科院分区：
文献类型：
--
作者：
Miller EH;Zucker J;Castor D;Annavajhala MK;Sepulveda JL;Green DA;Whittier S;Scherer M;Medrano N;Sobieszczyk ME;Yin MT;Kuhn L;Uhlemann AC
目前尚不清楚严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）病毒载量与住院和门诊患者症状持续时间之间的关系，以及这些因素对患者预后的影响。了解这些关联对于照顾2019冠状病毒病（COVID-19）患者的临床医生很重要。我们于2020年3月10日至5月30日在纽约市的一家大型第四纪学术医疗中心进行了一项观察性研究。从电子病历中提取患者特征、实验室值和临床结果。在此期间接受SARS-CoV-2检测的所有患者（N = 16 384）中，有5467例患者检测呈阳性，其中4254例患者具有可用的周期阈值（Ct），并被纳入进一步分析。单变量和多变量logistic回归模型用于检验Ct值、检测前症状持续时间、患者特征和死亡率之间的相关性。主要结局定义为死亡或出院进入安宁疗护。诊断时较低的Ct值（即较高的病毒载量）与住院和门诊患者中较高的死亡率显著相关。值得注意的是，从出现症状到检测时间较短的患者预后较差，那些出现症状不到3天的患者死亡几率增加了2倍。在调整症状出现的时间和其他临床协变量后，Ct值仍然是死亡率的一个强有力的预测因子。严重急性呼吸综合征冠状病毒2逆转录聚合酶链反应Ct值和症状持续时间与死亡率密切相关。这两个因素为临床医生对COVID-19患者进行风险分层提供了有用的信息。症状出现前的持续时间是COVID-19患者预后不良的独立预测因素。出现症状前3天的患者死亡几率增加2倍。此外，SARS-CoV-2 Ct值是死亡率的预测因子。
The relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and patient symptom duration in both in- and outpatients, and the impact of these factors on patient outcomes, are currently unknown. Understanding these associations is important to clinicians caring for patients with coronavirus disease 2019 (COVID-19). We conducted an observational study between March 10 and May 30, 2020 at a large quaternary academic medical center in New York City. Patient characteristics, laboratory values, and clinical outcomes were abstracted from the electronic medical records. Of all patients tested for SARS-CoV-2 during this time (N = 16 384), there were 5467 patients with positive tests, 4254 of which had available cycle threshold (Ct) values and were included in further analysis. Univariable and multivariable logistic regression models were used to test associations between Ct values, duration of symptoms before testing, patient characteristics, and mortality. The primary outcome is defined as death or discharge to hospice. Lower Ct values at diagnosis (ie, higher viral load) were associated with significantly higher mortality among both in- and outpatients. It is interesting to note that patients with a shorter time since the onset of symptoms to testing had a worse prognosis, with those presenting less than 3 days from symptom onset having 2-fold increased odds of death. After adjusting for time since symptom onset and other clinical covariates, Ct values remained a strong predictor of mortality. Severe acute respiratory syndrome coronavirus 2 reverse-transcription polymerase chain reaction Ct value and duration of symptoms are strongly associated with mortality. These 2 factors add useful information for clinicians to risk stratify patients presenting with COVID-19. Duration of symptoms before presentation is an independent predictor of poor patient outcomes in COVID-19 disease. Patients presenting in the first 3 days of symptoms have 2-fold increased odds of death. Moroever, SARS-CoV-2 Ct values are a predictor of mortality.
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影响因子：
8.8
作者：
Granados, Andrea;Peci, Adriana;Gubbay, Jonathan B.
通讯作者：
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影响因子：
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DOI：
10.1001/jama.2020.6775
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