Prolonged RT-PCR test positivity in hemodialysis patients with COVID-19

Renal Replacement Therapy

Research

Erica Franceschini¹  Mariacristina Gregorini²  Annachiara Ferrari²  Gaetano Alfano³  Giacomo Mori³  Francesco Fontana³  Gabriele Donati⁴  Riccardo Magistroni⁴  Niccolò Morisi⁵  Giulia Ligabue⁵  Gianni Cappelli⁵  Camilla Ferri⁵  Silvia Giovanella⁶  Giovanni Guaraldi⁷  Sara Tagliazucchi⁸  Monica Pecorari⁸ 

[1] Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy;Nephrology and Dialysis Unit, Azienda USL-IRCCS Arcispedale S. Maria Nuova Reggio Emilia, Reggio Emilia, Italy;Nephrology, Dialysis and Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Via del Pozzo 71, 41124, Modena, Italy;Nephrology, Dialysis and Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Via del Pozzo 71, 41124, Modena, Italy;Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy;Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy;Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy;Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy;Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy;Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy;Virology and Molecular Microbiology Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy;

关键词: COVID-19;    Vaccine;    Mortality;    SARS-COV-2;    Virus shedding;    Ct value;    RT-PCR;    Hemodialysis;    Virus hesitancy;    Hospitalization;   

DOI  :  10.1186/s41100-023-00487-y

 received in 2022-06-27, accepted in 2023-06-22,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe weakened immune system of patients on hemodialysis (HD) may prolong SARS-CoV-2 infection compared to the general population. Current international guidelines recommend ending isolation in conjunction with serial testing in moderately and severely immunocompromised subjects. This study aimed to estimate SARS-CoV-2 infectivity by measuring RT-PCR test positivity in HD patients. A comparison between RT-PCR test and cycle threshold (Ct) value has been performed as a secondary endpoint.MethodsA single-center retrospective study was conducted at the University of Modena (Italy) from March 2020 to October 2022. Only patients on chronic HD therapy with COVID-19 were enrolled in the study. In our HD Center, two negative nasopharyngeal reverse transcription polymerase chain reaction (RT-PCR) results were used to end quarantine in this population. SARS-CoV-2 RT-PCR test positivity duration measured the time elapsed from a positive RT-PCR to a second negative test. Ct cut-off of 35 cycles was used to definite “high Ct value,” a condition characterized by a large number of cycles of PCR amplification to register a positive RT-PCR test.ResultsDuring the observational period, 159 cases of SARS-CoV-2 infections were diagnosed in 151 patients. Median age was 70.1 (54.3–81.6) years and males accounted for 59.6% of the COVID-19 population. Median duration of SARS-CoV-2 RT-PCR test positivity on the nasal mucosa accounted for 30 (IQR, 21–40.5) days. Unvaccinated patients experienced significantly longer RT-PCR test positivity compared to vaccinated patients (42 [IQR,31–56] vs. 28 [IQR,20–35.7] days; p =  < 0.001). The use of high Ct value, a laboratory surrogate of SARS-CoV-2 replication, anticipated a negative RT-PCR test of 9 (IQR, 6–12) days. Multivariate linear regression analysis showed that increased age (β coefficient 0.31; confidence interval [CI] 95%, 0.14—0.43; p =  < 0.001) and the lack of anti-SARS-CoV-2 vaccination (β 0.49 CI95%, 11.9–22.5; p =  < 0.001) were predictors of a prolonged RT-PCR positivity.ConclusionsPatients with COVID-19 on HD had prolonged RT-PCR test positivity. The adoption of “high Ct value” criteria led to a significant reduction in the duration of RT-PCR test positivity compared to the use of the classical nucleic acid amplification test. In our study, the lack of SARS-CoV-2 vaccination and older age were independently associated with a longer RT-PCR positivity.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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