Misinterpretation of viral load in COVID-19 clinical outcomes

•The raw Ct could lead to misinterpretation of viral load.•The normalization of Ct values has a great impact on interpretation of viral load.•Data for profiles of viral load are important to infection control and vaccination. Knowledge of viral load is essential to formulate strategies for antiviral...

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Bibliographic Details
Published in:Virus research 2021-04, Vol.296, p.198340-198340, Article 198340
Main Authors: Miranda, Renan Lyra, Guterres, Alexandro, de Azeredo Lima, Carlos Henrique, Filho, Paulo Niemeyer, Gadelha, Mônica R.
Format: Article
Language:English
Subjects:
Clinical outcomes
COVID-19
COVID-19 - diagnosis
COVID-19 - virology
Ct values
Diagnostic Errors
Humans
Nasopharynx - virology
Real-Time Polymerase Chain Reaction
RNA, Viral - analysis
SARS-CoV-2
SARS-CoV-2 - isolation & purification
Viral Load
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Summary:•The raw Ct could lead to misinterpretation of viral load.•The normalization of Ct values has a great impact on interpretation of viral load.•Data for profiles of viral load are important to infection control and vaccination. Knowledge of viral load is essential to formulate strategies for antiviral treatment, vaccination, and epidemiological control of COVID-19. Moreover, identification of patients with high viral loads can also be useful to understand risk factors such as age, comorbidities, severity of symptoms and hypoxia, to decide on the need for hospitalization. Several ongoing studies are analyzing viral load in different types of samples and evaluating its relationship with clinical outcomes and viral transmission pathways. However, in a great number of emerging studies, cycle threshold (Ct) values alone are often used as viral load indicators, which may be a mistake. In this study, we compared tracheal aspirate with nasopharyngeal swab samples obtained from critically ill COVID-19 patients and here we report how the raw Ct can lead to misinterpretation of results. Furthermore, based on analysis of nasopharyngeal swab samples we propose a method to reduce evaluation errors that could occur from using raw Ct data. Based on these findings, we show the impact that normalization of Ct values has on interpretation of SARS-CoV-2 viral load from different biological samples.
ISSN:0168-1702
1872-7492
DOI:10.1016/j.virusres.2021.198340