Prolonged RT-PCR test positivity in hemodialysis patients with COVID-19
Abstract Background The 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. T...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | Renal Replacement Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41100-023-00487-y |
| _version_ | 1797773992781676544 |
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| author | Gaetano Alfano Niccolò Morisi Camilla Ferri Francesco Fontana Silvia Giovanella Giulia Ligabue Giacomo Mori Erica Franceschini Annachiara Ferrari Mariacristina Gregorini Gianni Cappelli Sara Tagliazucchi Monica Pecorari Giovanni Guaraldi Riccardo Magistroni Gabriele Donati |
| author_facet | Gaetano Alfano Niccolò Morisi Camilla Ferri Francesco Fontana Silvia Giovanella Giulia Ligabue Giacomo Mori Erica Franceschini Annachiara Ferrari Mariacristina Gregorini Gianni Cappelli Sara Tagliazucchi Monica Pecorari Giovanni Guaraldi Riccardo Magistroni Gabriele Donati |
| author_sort | Gaetano Alfano |
| collection | DOAJ |
| description | Abstract Background The 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. Methods A 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. Results During 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. Conclusions Patients 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. |
| first_indexed | 2024-03-12T22:13:29Z |
| format | Article |
| id | doaj.art-fc291f26c1ab4bbb9d5d9747e44e98e6 |
| institution | Directory Open Access Journal |
| issn | 2059-1381 |
| language | English |
| last_indexed | 2024-03-12T22:13:29Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Renal Replacement Therapy |
| spelling | doaj.art-fc291f26c1ab4bbb9d5d9747e44e98e62023-07-23T11:27:03ZengBMCRenal Replacement Therapy2059-13812023-07-01911810.1186/s41100-023-00487-yProlonged RT-PCR test positivity in hemodialysis patients with COVID-19Gaetano Alfano0Niccolò Morisi1Camilla Ferri2Francesco Fontana3Silvia Giovanella4Giulia Ligabue5Giacomo Mori6Erica Franceschini7Annachiara Ferrari8Mariacristina Gregorini9Gianni Cappelli10Sara Tagliazucchi11Monica Pecorari12Giovanni Guaraldi13Riccardo Magistroni14Gabriele Donati15Nephrology, Dialysis and Transplant Unit, Azienda Ospedaliero-Universitaria di ModenaSurgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio EmiliaSurgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio EmiliaNephrology, Dialysis and Transplant Unit, Azienda Ospedaliero-Universitaria di ModenaSurgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio EmiliaSurgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio EmiliaNephrology, Dialysis and Transplant Unit, Azienda Ospedaliero-Universitaria di ModenaInfectious Diseases Unit, Azienda Ospedaliero-Universitaria di ModenaNephrology and Dialysis Unit, Azienda USL-IRCCS Arcispedale S. Maria Nuova Reggio EmiliaNephrology and Dialysis Unit, Azienda USL-IRCCS Arcispedale S. Maria Nuova Reggio EmiliaSurgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio EmiliaVirology and Molecular Microbiology Unit, Azienda Ospedaliero-Universitaria di ModenaVirology and Molecular Microbiology Unit, Azienda Ospedaliero-Universitaria di ModenaSurgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio EmiliaNephrology, Dialysis and Transplant Unit, Azienda Ospedaliero-Universitaria di ModenaNephrology, Dialysis and Transplant Unit, Azienda Ospedaliero-Universitaria di ModenaAbstract Background The 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. Methods A 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. Results During 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. Conclusions Patients 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.https://doi.org/10.1186/s41100-023-00487-yCOVID-19VaccineMortalitySARS-COV-2Virus sheddingCt value |
| spellingShingle | Gaetano Alfano Niccolò Morisi Camilla Ferri Francesco Fontana Silvia Giovanella Giulia Ligabue Giacomo Mori Erica Franceschini Annachiara Ferrari Mariacristina Gregorini Gianni Cappelli Sara Tagliazucchi Monica Pecorari Giovanni Guaraldi Riccardo Magistroni Gabriele Donati Prolonged RT-PCR test positivity in hemodialysis patients with COVID-19 Renal Replacement Therapy COVID-19 Vaccine Mortality SARS-COV-2 Virus shedding Ct value |
| title | Prolonged RT-PCR test positivity in hemodialysis patients with COVID-19 |
| title_full | Prolonged RT-PCR test positivity in hemodialysis patients with COVID-19 |
| title_fullStr | Prolonged RT-PCR test positivity in hemodialysis patients with COVID-19 |
| title_full_unstemmed | Prolonged RT-PCR test positivity in hemodialysis patients with COVID-19 |
| title_short | Prolonged RT-PCR test positivity in hemodialysis patients with COVID-19 |
| title_sort | prolonged rt pcr test positivity in hemodialysis patients with covid 19 |
| topic | COVID-19 Vaccine Mortality SARS-COV-2 Virus shedding Ct value |
| url | https://doi.org/10.1186/s41100-023-00487-y |
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