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. 2021 Dec 6;73(11):e4197-e4205.
doi: 10.1093/cid/ciaa851.

Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Viral Load on Risk of Intubation and Mortality Among Hospitalized Patients With Coronavirus Disease 2019

Reed Magleby  1 , Lars F Westblade  1   2   3 , Alex Trzebucki  1 , Matthew S Simon  1   2 , Mangala Rajan  2 , Joel Park  1   4 , Parag Goyal  1   2 , Monika M Safford  1   2 , Michael J Satlin  1   2
Affiliations

Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Viral Load on Risk of Intubation and Mortality Among Hospitalized Patients With Coronavirus Disease 2019

Reed Magleby et al. Clin Infect Dis. .

Abstract

Background: Patients hospitalized with coronavirus disease 2019 (COVID-19) frequently require mechanical ventilation and have high mortality rates. However, the impact of viral burden on these outcomes is unknown.

Methods: We conducted a retrospective cohort study of patients hospitalized with COVID-19 from 30 March 2020 to 30 April 2020 at 2 hospitals in New York City. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load was assessed using cycle threshold (Ct) values from a reverse transcription-polymerase chain reaction assay applied to nasopharyngeal swab samples. We compared characteristics and outcomes of patients with high, medium, and low admission viral loads and assessed whether viral load was independently associated with intubation and in-hospital mortality.

Results: We evaluated 678 patients with COVID-19. Higher viral load was associated with increased age, comorbidities, smoking status, and recent chemotherapy. In-hospital mortality was 35.0% (Ct <25; n = 220), 17.6% (Ct 25-30; n = 216), and 6.2% (Ct >30; n = 242) with high, medium, and low viral loads, respectively (P < .001). The risk of intubation was also higher in patients with a high viral load (29.1%) compared with those with a medium (20.8%) or low viral load (14.9%; P < .001). High viral load was independently associated with mortality (adjusted odds ratio [aOR], 6.05; 95% confidence interval [CI], 2.92-12.52) and intubation (aOR, 2.73; 95% CI, 1.68-4.44).

Conclusions: Admission SARS-CoV-2 viral load among hospitalized patients with COVID-19 independently correlates with the risk of intubation and in-hospital mortality. Providing this information to clinicians could potentially be used to guide patient care.

Keywords: SARS-CoV-2; coronavirus disease 2019; hospitalized patients; outcomes; viral load.

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Figures

Figure 1.
Figure 1.
Study flow diagram. Abbreviations: ED, emergency department; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 2.
Figure 2.
Probability of in-hospital survival (A) and freedom from intubation (B) during COVID-19 hospitalization among patients with high, medium, and low viral loads. A medium viral load was associated with a hazard ratio (HR) of in-hospital mortality of 2.52 (95% confidence interval [CI], 1.36–4.67; P = .003) and a HR of intubation of 1.53 (95% CI, .91–2.60; P = .11) compared with a low viral load. A high viral load was associated with a HR of in-hospital mortality of 5.06 (95% CI, 2.86–8.96; P < .001) and a HR of intubation of 2.15 (95% CI, 1.31–3.53; P = .003) compared with a low viral load.
Figure 3.
Figure 3.
Cycle threshold values from nasopharyngeal swab samples on admission and risk of intubation and death during the hospitalization.
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