414 - Association of SARS-CoV-2 Genomic Load Trends with Clinical Status in COVID-19:A Retrospective Analysis from an Academic Hospital Center in New York City

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Presenting Author(s)

ioannis Zacharioudakis

Assistant professor, Department of Medicine, Infectious Diseases
New York University
New York city, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

fainareti Zervou

Infectious Disease Fellow
new york university
New york city, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
PP

Prithiv Prasad

Clinical Instructor, Infectious Diseases
NYU Grossman School of Medicine
New York, NY
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
YS

Yongzhao Shao

Professor
NYU
New York, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AB

Atreyee Basu

Pathology resident
NYU
New York, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KI

Kenneth Inglima

Microbiology lab manager
NYU Langone Health
New York, NY
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SW

Scott Weisenberg

Clinical Associate Professor
NYU
New York, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MA

Maria E. Aguero-Rosenfeld

Professor, Department of Pathology, Professor, Department of Medicine
New York University
New York City, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: The Infectious Diseases Society of America has identified the potential use of SARS-CoV-2 genomic load for prognostication purposes as a key research question.

Methods: We designed a retrospective cohort study that included adult patients with COVID-19 pneumonia who had at least 2 positive nasopharyngeal tests at least 24 hours apart to study the correlation between the change in the genomic load of SARS-CoV-2 in nasopharyngeal samples, as reflected by the Cycle threshold (Ct) value of the real-time Polymerase Chain Reaction (PCR) assay, with change in clinical status. The Sequential Organ Failure Assessment (SOFA) score was used as a surrogate for patients’ clinical status. A linear mixed-effects regression analysis was performed.

Results: Among 457 patients who presented to the emergency department between 3/31/2020- 4/10/2020, we identified 42 patients who met the inclusion criteria. The median initial SOFA score was 2 (IQR 2-3). 20 out of 42 patients had a lower SOFA score on their subsequent tests. We identified a statistically significant inverse correlation between the change in SOFA score and change in the Ct value with a decrease in SOFA score by 0.05 (SE 0.02; p < 0.05) for an increase in Ct values by 1. This correlation was independent of the duration of symptoms.Flow chart

A graph of the Cycle Threshold (Ct) values of the of Cepheid Xpert® Xpress SARS-CoV-2 assay measured on repeat screening of the 42 included patients.

Graph of the fitted SOFA scores based on the Cycle Threshold values per patient.

Conclusion: Our findings suggest that an increasing Ct value in sequential tests may be of prognostic value for patients diagnosed with COVID-19 pneumonia. Before repeat testing can be recommended routinely in clinical practice as a predictor of disease outcomes, prospective studies with a standardized interval between repeat tests should confirm our findings.