SARS-CoV-2 RT-PCR Cycle Threshold Value and Its Association with Disease Severity and Mortality among Hospitalized Pediatric COVID-19 Patients
Aubrey O. Artienda, M.D. and Jay Ron O. Padua, M.D.

ABSTRACT
Objective: This study determined the association of SARS-CoV-2 RT-PCR cycle threshold (Ct) value with disease severity and mortality among hospitalized pediatric COVID-19 patients.
Methodology: This is a retrospective cohort study of patients aged 0-18 years with SARS-CoV-2 RT-PCR-confirmed COVID-19 from 1-September-2020 to 31-August-2022. The cohort was divided into those with high (>30), medium (> 20) and low (</= 20) Ct values. Association between Ct values and disease severity was determined using Chi-square test and association between Ct values and mortality was determined using logistic regression.
Results: There were 236 patients included with male predominance. Median age was 7 years. Most belonged to the 0-5 years age group. Most were severe to critical COVID-19 cases. Median day of illness on swab collection was 4 days. Majority presented with symptoms such as fever (54%), cough (22%) and dyspnea (22%). Eighty-four percent had co-morbidities, of which majority were cancer and neurologic diseases. Median Ct value was 30.81. Fifty-four percent had high Ct values. The median age of patients with a high Ct value was significantly lower than other cohorts. The median day of illness of patients with low Ct value was significantly shorter than other cohorts. There
was no significant difference across the terciles in terms of presence of co-morbidities. Majority of patients for each cohort had high Ct values. There was no significant association between Ct value and COVID-19 disease severity on admission. Nearly fifty percent had critical disease and the all-cause mortality rate was 21.61%. There was no significant association between Ct value and mortality.
Conclusions: Ct value was not associated with disease severity and all-cause mortality after controlling for confounders. A look into medical interventions, emergence of variants, and other factors that may affect the clinical presentation, disease course, severity and outcome are recommended in future studies.

Keywords: COVID-19, Cycle Threshold Value, Disease Severity, Mortality, Outcome, Pediatric Patients
https://doi.org/10.56964/pidspj20232402007
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