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. 2021 Nov 2;73(9):e2995-e3001.
doi: 10.1093/cid/ciaa1285.

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

Karl Hagman  1   2 , Magnus Hedenstierna  1 , Patrik Gille-Johnson  1 , Berit Hammas  3 , Malin Grabbe  3 , Joakim Dillner  4 , Johan Ursing  1   2
Affiliations

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

Karl Hagman et al. Clin Infect Dis. .

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.

Keywords: SARS-CoV-2; COVID-19; mortality; viral load; viremia.

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Figures

Figure 1.
Figure 1.
Flowchart for study population. Abbreviations: COVID-19, coronavirus disease 2019; IQR, interquartile range; PCR, polymerase chain reaction.
Figure 2.
Figure 2.
Kaplan-Meier estimates of all-cause mortality. Survival of patients without (dashed line) and with (solid line) severe acute respiratory syndrome coronavirus 2 RNA in serum at admission. Abbreviation: PCR, polymerase chain reaction.
Figure 3.
Figure 3.
Kaplan-Meier estimates of progression to critical disease. Estimates of progression to critical disease, defined as a composite of intensive care unit care and all-cause mortality. Patients without (dashed line) and with (solid line) severe acute respiratory syndrome coronavirus 2 RNA in serum at admission. Abbreviation: PCR, polymerase chain reaction.
Figure 4.
Figure 4.
Proportion of severe acute respiratory syndrome coronavirus 2 serum polymerase chain reaction (PCR)–positive patients in different age groups.
See this image and copyright information in PMC

References

    1. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382:727–33. - PMC - PubMed
    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395:497–506. - PMC - PubMed
    1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395:1054–62. - PMC - PubMed
    1. Vabret N, Britton GJ, Gruber C, et al. Sinai Immunology Review Project . Immunology of COVID-19: current state of the science. Immunity 2020; 52:910–41. - PMC - PubMed
    1. Wong CK, Lam CW, Wu AK, et al. Plasma inflammatory cytokines and chemokines in severe acute respiratory syndrome. Clin Exp Immunol 2004; 136:95–103. - PMC - PubMed

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