TMSS Medical College Journal

Background: Patients hospitalized with coronavirus disease 2019 (COVID-19) have high mortality rates and also showed many laboratory abnormalities but the relationship between clinical presentation, mortality and laboratory features with viral load is still under research. Materials and Methods: We conducted a retrospective study of patients hospitalized with COVID-19 from 5th August 2020 to 15th December 2020 at TMSS Medical College and Rafatullah Community hospital in Bogura. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load was assessed using cycle threshold (Ct) values from a reverse transcription-polymerase chain reaction assay applied to nasopharyngeal swab samples. We compared clinical presentation, outcomes and laboratory features of patients with high, medium, and low admission viral loads and assessed whether viral load was associated with mortality and other laboratory abnormalities. Results: We evaluated 253 patients with COVID-19 confirmed by RT-PCR. In-hospital mortality was 36%, 17% and 7% with high, medium, and low viral loads, respectively (P <.05). Viral load was associated with increased neutrophil count, decreased lymphocyte count and elevated CRP. Conclusions: Admission SARS-CoV-2 viral load among hospitalized patients with COVID-19 correlates with in-hospital mortality. Viral load was also associated with some laboratory abnormalities. Providing this information to clinicians could potentially be used to guide patient care.

Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is a novel pathogen that has rapidly caused a devastating pandemic of coronavirus disease 2019 (COVID-19). As of 19 January 2021, SARS-CoV-2 had infected more than 138 million people and killed more than 2.92 million people throughout the world '. In Bangladesh, from the first case identified in early march 2020, a total of 697,985 individuals tested positive for covid-19, and 9,891 died with case fatality 1.42% up to 12 April 2021% Although the majority of patients who develop COVID-19 have mild presentations’, up to 20% of hospitalized patients die*®. Investigations of risk factors and mortality with COVID-19 in hospitalized patients have largely focused on patient characteristics, such as older age, obesity, and comorbidities, as well as presenting symptoms and laboratory parameters’. In contrast, the impact of SARS-CoV-2 viral load on clinical outcomes in hospitalized patients has rarely been thoroughly investigated. Association of viral load with patient’s mortality, clinical presentation, hematological, biochemical and infection related parameters is an area of research. The current standard-of-care test to diagnose COVID-19 is to collect a nasopharyngeal (NP) swab and use a reverse transcription-polymerase chain reaction (RT-PCR) assay to detect SARS-CoV-2 RNA. These RT-PCR assays provide clinicians only with information on whether SARS-CoV-2 is detected or not detected. However, these assays also contain quantitative information on cycle threshold (Ct) values that are inversely correlated with viral load and are not reported clinically. We hypothesized that assessing SARS-CoV-2 viral load by analyzing Ct values from an initial NP swab sample could be a clinically valuable tool for predicting in-hospital mortality and associated with laboratory abnormalities. We therefore conducted this retrospective analysis of SARS-CoV-2 viral loads on admission to find out any association with patient’s clinical presentations, outcomes and laboratory abnormalities at TMSS Medical College and Rafatullah community hospital using a RT-PCR assay.