Severe Acute Respiratory Syndrome Coronavirus 2 RNA in Serum as Predictor of Severe Outcome in Coronavirus Disease 2019: A Retrospective Cohort Study

Clinical Infectious Diseases - Tập 73 Số 9 - Trang e2995-e3001 - 2021
Karl Hagman1,2, Magnus Hedenstierna2, Patrik Gille-Johnson2, Berit Hammas3, Malin Grabbe3, Joakim Dillner4, Johan Ursing1,2
1Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
2Department of Infectious Diseases, Danderyd Hospital, Stockholm, Sweden
3Department of Microbiology, Karolinska University Hospital, Stockholm, Sweden
4Karolinska University Laboratory, Stockholm, Sweden

Tóm tắt

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19). This study aimed to determine if SARS-CoV-2 RNA in serum at admission correlated with clinical outcome in COVID-19. Methods COVID-19 patients admitted to the infectious diseases department of a tertiary level Swedish hospital and sampled for SARS-CoV-2 RNA in serum at admission during 10 April to 30 June 2020 were included. Primary outcomes were day 28 all-cause mortality and progress to critical disease. Results The cohort (N = 167) consisted of 106 SARS-CoV-2 RNA serum-negative and 61 serum-positive patients. Median sampling time for initial SARS-CoV-2 in serum was 1 day (interquartile range [IQR], 1–2 days) after admission, corresponding to day 10 (IQR, 8–12) after symptom onset. Median age was 53 years (IQR, 44–67 years) and 63 years (IQR, 52–74 years) for the serum–negative and -positive patients, respectively. In the serum-negative and -positive groups, 3 of 106 and 15 of 61 patients died, respectively. The hazard ratios for critical disease and all-cause mortality were 7.2 (95% confidence interval [CI], 3.0–17) and 8.6 (95% CI, 2.4–30), respectively, for patients with serum–positive compared to serum–negative results. Conclusions SARS-CoV-2 RNA in serum at hospital admission indicates a high risk of progression to critical disease and death.

Từ khóa


Tài liệu tham khảo

Zhu, 2020, A novel coronavirus from patients with pneumonia in China, 2019, N Engl J Med, 382, 727, 10.1056/NEJMoa2001017

Huang, 2020, Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, Lancet, 395, 497, 10.1016/S0140-6736(20)30183-5

Zhou, 2020, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet, 395, 1054, 10.1016/S0140-6736(20)30566-3

Vabret, 2020, Immunology of COVID-19: current state of the science, Immunity, 52, 910, 10.1016/j.immuni.2020.05.002

Wong, 2004, Plasma inflammatory cytokines and chemokines in severe acute respiratory syndrome, Clin Exp Immunol, 136, 95, 10.1111/j.1365-2249.2004.02415.x

Peiris, 2004, Severe acute respiratory syndrome, Nat Med, 10, S88, 10.1038/nm1143

Oh, 2016, Viral load kinetics of MERS coronavirus infection, N Engl J Med, 375, 1303, 10.1056/NEJMc1511695

Zheng, 2020, Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January–March 2020: retrospective cohort study, BMJ, 369, m1443, 10.1136/bmj.m1443

Magleby, 2020, Impact of SARS-CoV-2 viral load on risk of intubation and mortality among hospitalized patients with coronavirus disease 2019, Clin Infect Dis, 10.1093/cid/ciaa851

Pujadas, 2020, SARS-CoV-2 viral load predicts COVID-19 mortality [manuscript published online ahead of print 6 August 2020], Lancet Respir Med, 10.1016/S2213-2600(20)30354-4

To, 2020, Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study, Lancet Infect Dis, 20, 565, 10.1016/S1473-3099(20)30196-1

Chen, 2020, Detectable serum SARS-CoV-2 viral load (RNAaemia) is closely correlated with drastically elevated interleukin 6 (IL-6) level in critically ill COVID-19 patients, Clin Infect Dis

Veyer, 2020, Highly sensitive quantification of plasma SARS-CoV-2 RNA shields light on its potential clinical value, Clin Infect Dis, 10.1093/cid/ciaa1196

Gong, 2020;, A tool to early predict severe corona virus disease 2019 (COVID-19): a multicenter study using the risk nomogram in Wuhan and Guangdong, China, Clin Infect Dis, 71, 833, 10.1093/cid/ciaa443

Liang, 2020, Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19, JAMA Intern Med, 10.1001/jamainternmed.2020.2033

Corman, 2020, Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR, Euro Surveill, 25, 2000045, 10.2807/1560-7917.ES.2020.25.3.2000045

World Health Organization

Cepheid, 2020

Wynants, 2020, Prediction models for diagnosis and prognosis of Covid-19 infection: systematic review and critical appraisal, BMJ, 369, m1328, 10.1136/bmj.m1328

Liu, 2020, The role of interleukin-6 in monitoring severe case of coronavirus disease 2019, EMBO Mol Med, 12, e12421, 10.15252/emmm.202012421

Cummings, 2020, Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study, Lancet, 395, 1763, 10.1016/S0140-6736(20)31189-2

Puelles, 2020, Multiorgan and renal tropism of SARS-CoV-2, N Engl J Med, 383, 590, 10.1056/NEJMc2011400

Wichmann, 2020, Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study, Ann Intern Med, 173, 268, 10.7326/M20-2003

Beigel, 2020, Remdesivir for the treatment of Covid-19—preliminary report, N Engl J Med, 10.1056/NEJMoa2007764

Joyner, 2020, Safety update: COVID-19 convalescent plasma in 20 000 hospitalized patients, Mayo Clin Proc, 95, 1888, 10.1016/j.mayocp.2020.06.028

Thông tin
Thông tin xuất bản

Clinical Infectious Diseases

Tập 73 Số 9

e2995-e3001

Thông tin tác giả