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SARS-CoV-2 RNAemia Predicts Clinical Deterioration and Extrapulmonary Complications from COVID-19

2021; Oxford University Press; Volume: 74; Issue: 2 Linguagem: Inglês

10.1093/cid/ciab394

1537-6591

Nikhil Ram-Mohan, David Kim, Elizabeth J. Zudock, Marjan Hashemi, Kristel C. Tjandra, Angela J. Rogers, Catherine A. Blish, Kari C. Nadeau, Jennifer A. Newberry, James Quinn, Ruth O’Hara, Euan A. Ashley, Hien Nguyen, Lingxia Jiang, Paul J. Hung, Andra L. Blomkalns, Samuel Yang, Rosen Mann, Anita Visweswaran, Thanmayi Ranganath, Jonasel Roque, Monali Manohar, Hena Din, Komal Kumar, Kathryn Jee, Brigit Noon, Jill Anderson, Bethany Fay, Donald Schreiber, Nancy Q. Zhao, Rosemary Vergara, Julia L. McKechnie, Aaron J. Wilk, Lauren de la Parte, Kathleen D. Press, Maureen Ty, Nimish Kathale, Arjun Rustagi, Giovanny J. Martínez-Colón, Geoffrey T. Ivison, Ruoxi Pi, Maddie Lee, Rachel Brewer, Taylor Hollis, Andrea Baird, Michele Ugur, Drina Bogusch, George R. Nahass, Kazim Haider, Kim Q.T. Tran, Laura J. Simpson, Michal Caspi Tal, Iris Chang, Evan Do, Andrea Fernandes, Alexandra S. Lee, Neera Ahuja, Theo Snow, James Krempski,

SARS-CoV-2 and COVID-19 Research

Abstract Background The determinants of coronavirus disease 2019 (COVID-19) disease severity and extrapulmonary complications (EPCs) are poorly understood. We characterized relationships between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNAemia and disease severity, clinical deterioration, and specific EPCs. Methods We used quantitative and digital polymerase chain reaction (qPCR and dPCR) to quantify SARS-CoV-2 RNA from plasma in 191 patients presenting to the emergency department with COVID-19. We recorded patient symptoms, laboratory markers, and clinical outcomes, with a focus on oxygen requirements over time. We collected longitudinal plasma samples from a subset of patients. We characterized the role of RNAemia in predicting clinical severity and EPCs using elastic net regression. Results Of SARS-CoV-2–positive patients, 23.0% (44 of 191) had viral RNA detected in plasma by dPCR, compared with 1.4% (2 of 147) by qPCR. Most patients with serial measurements had undetectable RNAemia within 10 days of symptom onset, reached maximum clinical severity within 16 days, and symptom resolution within 33 days. Initially RNAemic patients were more likely to manifest severe disease (odds ratio, 6.72 [95% confidence interval, 2.45–19.79]), worsening of disease severity (2.43 [1.07–5.38]), and EPCs (2.81 [1.26–6.36]). RNA loads were correlated with maximum severity (r = 0.47 [95% confidence interval, .20–.67]). Conclusions dPCR is more sensitive than qPCR for the detection of SARS-CoV-2 RNAemia, which is a robust predictor of eventual COVID-19 severity and oxygen requirements, as well as EPCs. Because many COVID-19 therapies are initiated on the basis of oxygen requirements, RNAemia on presentation might serve to direct early initiation of appropriate therapies for the patients most likely to deteriorate.