tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2021 Oct 6;8(11)
fab509.
doi: 10.1093/ofid/ofab509. eCollection 2021 Nov.
SARS-CoV-2 Blood RNA Load Predicts Outcome in Critically Ill COVID-19 Patients
Fabian Heinrich[SUP] 1 [/SUP], Michael F Nentwich[SUP] 2 [/SUP], Eric Bibiza-Freiwald[SUP] 1 [/SUP], Dominik Nörz[SUP] 1 [/SUP], Kevin Roedl[SUP] 2 [/SUP], Martin Christner[SUP] 1 [/SUP], Armin Hoffmann[SUP] 1 [/SUP], Flaminia Olearo[SUP] 1 [/SUP], Stefan Kluge[SUP] 2 [/SUP], Martin Aepfelbacher[SUP] 1 [/SUP], Dominic Wichmann[SUP] 2 [/SUP], Marc Lütgehetmann[SUP] 1 [/SUP], Susanne Pfefferle[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA loads in patient specimens may act as a clinical outcome predictor in critically ill patients with coronavirus disease 2019 (COVID-19).
Methods: We evaluated the predictive value of viral RNA loads and courses in the blood compared with the upper and lower respiratory tract loads of critically ill COVID-19 patients. Daily specimen collection and viral RNA quantification by reverse transcription quantitative polymerase chain reaction were performed in all consecutive 170 COVID-19 patients between March 2020 and February 2021 during the entire intensive care unit (ICU) stay (4145 samples analyzed). Patients were grouped according to their 90-day outcome as survivors (n=100) or nonsurvivors (n=70).
Results: In nonsurvivors, blood SARS-CoV-2 RNA loads were significantly higher at the time of admission to the ICU (P=.0009). Failure of blood RNA clearance was observed in 33/50 (66%) of the nonsurvivors compared with 12/64 (19%) survivors (P<.0001). As determined by multivariate analysis, taking sociodemographic and clinical parameters into account, blood SARS-CoV-2 RNA load represents a valid and independent predictor of outcome in critically ill COVID-19 patients (odds ratio [OR; log[SUB]10[/SUB]], 0.23; 95% CI, 0.12-0.42; P<.0001), with a significantly higher effect for survival compared with respiratory tract SARS-CoV-2 RNA loads (OR [log[SUB]10[/SUB]], 0.75; 95% CI, 0.66-0.85; P<.0001). Blood RNA loads exceeding 2.51×103 SARS-CoV-2 RNA copies/mL were found to indicate a 50% probability of death. Consistently, 29/33 (88%) nonsurvivors with failure of virus clearance exceeded this cutoff value constantly.
Conclusions: Blood SARS-CoV-2 load is an important independent outcome predictor and should be further evaluated for treatment allocation and patient monitoring.
Keywords: 2; 2 RNA load; CoV; SARS; kinetics; viremia.
. 2021 Oct 6;8(11)
fab509.doi: 10.1093/ofid/ofab509. eCollection 2021 Nov.
SARS-CoV-2 Blood RNA Load Predicts Outcome in Critically Ill COVID-19 Patients
Fabian Heinrich[SUP] 1 [/SUP], Michael F Nentwich[SUP] 2 [/SUP], Eric Bibiza-Freiwald[SUP] 1 [/SUP], Dominik Nörz[SUP] 1 [/SUP], Kevin Roedl[SUP] 2 [/SUP], Martin Christner[SUP] 1 [/SUP], Armin Hoffmann[SUP] 1 [/SUP], Flaminia Olearo[SUP] 1 [/SUP], Stefan Kluge[SUP] 2 [/SUP], Martin Aepfelbacher[SUP] 1 [/SUP], Dominic Wichmann[SUP] 2 [/SUP], Marc Lütgehetmann[SUP] 1 [/SUP], Susanne Pfefferle[SUP] 1 [/SUP]
Affiliations
- PMID: 34796247
- PMCID: PMC8522363
- DOI: 10.1093/ofid/ofab509
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA loads in patient specimens may act as a clinical outcome predictor in critically ill patients with coronavirus disease 2019 (COVID-19).
Methods: We evaluated the predictive value of viral RNA loads and courses in the blood compared with the upper and lower respiratory tract loads of critically ill COVID-19 patients. Daily specimen collection and viral RNA quantification by reverse transcription quantitative polymerase chain reaction were performed in all consecutive 170 COVID-19 patients between March 2020 and February 2021 during the entire intensive care unit (ICU) stay (4145 samples analyzed). Patients were grouped according to their 90-day outcome as survivors (n=100) or nonsurvivors (n=70).
Results: In nonsurvivors, blood SARS-CoV-2 RNA loads were significantly higher at the time of admission to the ICU (P=.0009). Failure of blood RNA clearance was observed in 33/50 (66%) of the nonsurvivors compared with 12/64 (19%) survivors (P<.0001). As determined by multivariate analysis, taking sociodemographic and clinical parameters into account, blood SARS-CoV-2 RNA load represents a valid and independent predictor of outcome in critically ill COVID-19 patients (odds ratio [OR; log[SUB]10[/SUB]], 0.23; 95% CI, 0.12-0.42; P<.0001), with a significantly higher effect for survival compared with respiratory tract SARS-CoV-2 RNA loads (OR [log[SUB]10[/SUB]], 0.75; 95% CI, 0.66-0.85; P<.0001). Blood RNA loads exceeding 2.51×103 SARS-CoV-2 RNA copies/mL were found to indicate a 50% probability of death. Consistently, 29/33 (88%) nonsurvivors with failure of virus clearance exceeded this cutoff value constantly.
Conclusions: Blood SARS-CoV-2 load is an important independent outcome predictor and should be further evaluated for treatment allocation and patient monitoring.
Keywords: 2; 2 RNA load; CoV; SARS; kinetics; viremia.