Efeitos da carga viral do SARS-CoV-2 nos parâmetros hematológicos e bioquímicos
DOI:
https://doi.org/10.15448/1980-6108.2025.1.46366Palavras-chave:
COVID-19. RTq-PCR. Biomarcadores.Resumo
Objetivo: a carga viral é determinada pelo cycle threshold (Ct), que é inversamente proporcional à quantidade de sequências-alvo presentes na amostra. Em várias doenças virais, a indução de citocinas inflamatórias está fortemente correlacionada com a carga viral. No entanto, a cinética viral do SARS-CoV-2 permanece pouco caracterizada e sua associação com a progressão da doença ainda é controversa. Este estudo teve como objetivo entender a correlação entre a carga viral do SARS-CoV-2 e os marcadores bioquímicos e hematológicos em pacientes positivos para COVID-19.
Métodos: os dados de pacientes com carga viral detectável para SARS-CoV-2 atendidos entre março de 2020 e maio de 2021 foram coletados entre janeiro de 2023 e janeiro de 2024. Os dados foram analisados utilizando a correlação de Pearson, o teste t de Student e a análise de variância.
Resultados: os valores médios de Ct para os genes N e ORF1AB foram 26,73 (±3,95) e 25,93 (±4,75), respectivamente. Um valor de Ct abaixo da média para os genes N e ORF1AB, sugerindo uma carga viral mais alta, foi observado em 17,8% (n=152) e 18,4% (n=157) dos pacientes. Não houve correlação entre a média de Ct e os parâmetros hematológicos ou bioquímicos, no entanto, a razão monócito-linfócito (MLR) estava abaixo do valor de referência para pacientes negativos para COVID-19 (P<0,0001). Os níveis de proteína C-reativa e ferritina encontravam-se mais altos em pacientes positivos para COVID-19 (P<0,05). Leucopenia (P<0,0001), linfocitopenia (P<0,0001), neutropenia (P<0,0001) e trombocitopenia (P=0,003) foram observadas com mais frequência em pacientes positivos para COVID-19.
Conclusão: uma MLR abaixo do valor de referência foi observada com mais frequência em pacientes com um valor de Ct mais alto (carga viral mais baixa).
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Referências
World Health Organization. WHO Coronavirus (COVID-19) dashboard [Internet]. 2020 [cited 2023 Jan 23]. Available at: https://covid19.who.int
Christensen B, Favaloro EJ, Lippi G, Van Cott EM. Hematology laboratory abnormalities in patients with coronavirus disease 2019 (COVID-19). Semin Thromb Hemost. 2020;46(07):845-9. https://doi.org/10.1055/s-0040-1715458 DOI: https://doi.org/10.1055/s-0040-1715458
Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med (CCLM). 2020;58(7):1131-4. https://doi.org/10.1515/cclm-2020-0198 DOI: https://doi.org/10.1515/cclm-2020-0198
Contreras C, Newby JM, Hillen T. Personalized virus load curves for acute viral infections. Viruses. 2021;13(9):1815. https://doi.org/10.3390/v13091815 DOI: https://doi.org/10.3390/v13091815
Ladeira PR, Isaac C, Ferreira MC. Reação em cadeia da polimerase da transcrição reversa em tempo real. Rev. Med. 2011;90(1):47. https://doi.org/10.11606/issn.1679-9836.v90i1p47-51 DOI: https://doi.org/10.11606/issn.1679-9836.v90i1p47-51
Wong ML, Medrano JF. Real-time PCR for mRNA quantitation. BioTechniques. 2005;39(1):75-85. https://doi.org/10.2144/05391rv01 DOI: https://doi.org/10.2144/05391RV01
Menezes ME, Lima LM, Martinello F. Diagnóstico laboratorial do SARS-CoV-2 por transcrição reversa seguida de reação em cadeia da polimerase em tempo real (RT-PCR). Rev Bras Anal Clin. 2020;52(2):122-30. https://doi.org/10.21877/2448-3877.20200006 DOI: https://doi.org/10.21877/2448-3877.20200006
Liu Y, Yan LM, Wan L, Xiang TX, Le A, Liu JM, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis. 2020;20(6):656-7. https://doi.org/10.1016/s1473-3099(20)30232-2 DOI: https://doi.org/10.1016/S1473-3099(20)30232-2
Magleby R, Westblade LF, Trzebucki A, Simon MS, Rajan M, Park J, et al. Impact of severe acute respiratory syndrome coronavirus 2 viral load on risk of intubation and mortality among hospitalized patients with coronavirus disease 2019. Clin Infect Dis. 2020;73(11):e4197-205. https://doi.org/10.1093/cid/ciaa851 DOI: https://doi.org/10.1093/cid/ciaa851
Brasil. Ministério da Saúde. Painel do Coronavirus [Intenet]. 2023 [cited 2023 May 09]. Available at: https://covid.saude.gov.br
Azzi L, Carcano G, Gianfagna F, Grossi P, Gasperina DD, Genoni A, et al. Saliva is a reliable tool to detect SARS-CoV-2. J Infect. 2020;81(1):e45-e50. https://doi.org/10.1016/j.jinf.2020.04.005 DOI: https://doi.org/10.1016/j.jinf.2020.04.005
World Health Organization. Laboratory testing strategy recommendations for COVID-19 [Internet]. Geneva: World Health Organization; 2020 [cited 2023 Nov 21]. Available at: https://apps.who.int/iris/handle/10665/331509
Walsh KA, Jordan K, Clyne B, Rohde D, Drummond L, Byrne P, et al. SARS-CoV-2 detection, viral load and infectivity over the course of an infection. J Infect. 2020;81(3):357-71. https://doi.org/10.1016/j.jinf.2020.06.067 DOI: https://doi.org/10.1016/j.jinf.2020.06.067
Rabaan AA, Tirupathi R, Sule AA, Aldali J, Mutair AA, Alhumaid S, et al. Viral dynamics and Real-Time RT-PCR Ct values correlation with disease severity in COVID-19. Diagnostics. 2021;11(6):1091. https://doi.org/10.3390/diagnostics11061091 DOI: https://doi.org/10.3390/diagnostics11061091
Rao SN, Manissero D, Steele VR, Pareja J. A narrative systematic review of the clinical utility of cycle threshold values in the context of COVID-19. Infect Dis Ther. 2020;9(3):573-86. https://doi.org/10.1007/s40121-020-00324-3 DOI: https://doi.org/10.1007/s40121-020-00324-3
Ataee Z, Rahmani A, Amel S, Khadem-Rezaiyan M, Ziaee M. Relationship of viral load with the laboratory markers and prognosis in COVID-19 patients. Med J Islam Repub Iran. 2023;37(1):544-8. https://doi.org/10.47176/mjiri.37.67 DOI: https://doi.org/10.47176/mjiri.37.67
Elshazli RM, Toraih EA, Elgaml A, El-Mowafy M, El-Mesery M, Amin MN, et al. Diagnostic and prognostic value of hematological and immunological markers in COVID-19 infection: a meta-analysis of 6320 patients. PLoS ONE. 2020;15(8):e0238160. https://doi.org/10.1371/journal.pone.0238160 DOI: https://doi.org/10.1371/journal.pone.0238160
Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis. 2020;14:1-14. https://doi.org/10.1177/1753466620937175 DOI: https://doi.org/10.1177/1753466620937175
Asai N, Sakanashi D, Ohashi W, Nakamura A, Yamada A, Kawamoto Y, et al. Could threshold cycle value correctly reflect the severity of novel coronavirus disease 2019 (COVID-19)? J Infect Chemother. 2021;27(1):117-9. https://doi.org/10.1016/j.jiac.2020.09.010 DOI: https://doi.org/10.1016/j.jiac.2020.09.010
Shoaib N, Iqbal A, Shah FA, Zainab W, Qasim M, Zerqoon N, et al. Population-level median cycle threshold (Ct) values for asymptomatic COVID-19 cases can predict the trajectory of future cases. PLoS ONE. 18(3):e0281899. https://doi.org/10.1371/journal.pone.0281899 DOI: https://doi.org/10.1371/journal.pone.0281899
Kleiboeker S, Cowden S, Grantham J, Nutt J, Tyler A, Berg A, et al. SARS-CoV-2 viral load assessment in respiratory samples. J Clin Virol. 2020;129:104439. https://doi.org/10.1016/j.jcv.2020.104439 DOI: https://doi.org/10.1016/j.jcv.2020.104439
Dahdouh E, Lázaro-Perona F, Romero-Gómez MP, Mingorance J, García-Rodriguez J. Ct values from SARS-CoV-2 diagnostic PCR assays should not be used as direct estimates of viral load. J Infect. 2021;82(3):414-51. https://doi.org/10.1016/j.jinf.2020.10.017 DOI: https://doi.org/10.1016/j.jinf.2020.10.017
Parimoo A, Biswas A, Baitha U, Gupta G, Pandey S, Ranjan P, et al. Dynamics of inflammatory markers in predicting mortality in COVID-19. Cureus. 2021;13(10):e19080. https://doi.org/10.7759/cureus.19080 DOI: https://doi.org/10.7759/cureus.19080
Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091. https://doi.org/10.1136/bmj.m1091 DOI: https://doi.org/10.1136/bmj.m1091
Şener G, Bayrak T, Coşkun C, Bayrak A. Neutrophil iymphocyte ratio, monocyte lymphocyte ratio, platelet lymphocyte ratio in Covid-19 patients. Clin Lab. 2022;68. https://doi.org/10.7754/clin.lab.2021.210639 DOI: https://doi.org/10.7754/Clin.Lab.2021.210639
Bull S, Jamrozik E, Binik A, Parker MJ. SARS-CoV-2 challenge studies: ethics and risk minimisation. J. Med. Ethics. 2021;47:e79. https://doi.org/10.1136/medethics-2020-106504 DOI: https://doi.org/10.1136/medethics-2020-106504
Peng J, Qi D, Yuan G, Deng X, Mei Y, Feng L, et al. Diagnostic value of peripheral hematologic markers for coronavirus disease 2019 (COVID‐19): a multicenter, cross‐sectional study. J Clin Lab Anal. 2020;34:e23475. https://doi.org/10.1002/jcla.23475 DOI: https://doi.org/10.1002/jcla.23475
Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol. 2017;39(5):529-39. https://doi.org/10.1007/s00281-017-0629-x DOI: https://doi.org/10.1007/s00281-017-0629-x
Felsenstein S, Herbert JA, McNamara PS, Hedrich CM. COVID-19: immunology and treatment options. Clin Immunol. 2020;215:108448. https://doi.org/10.1016/j.clim.2020.108448 DOI: https://doi.org/10.1016/j.clim.2020.108448
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