The impact of viremia on organ failure, biomarkers and mortality in a Swedish cohort of critically ill COVID-19 patients

Abstract

The spread of virus via the blood stream has been suggested to contribute to extra-pulmonary organ failure in Coronavirus disease 2019 (COVID-19). We assessed SARS-CoV-2 RNAemia (RNAemia) and the association between RNAemia and inflammation, organ failure and mortality in critically ill COVID-19 patients. We included all patients with PCR verified COVID-19 and consent admitted to ICU. SARS-CoV-2 RNA copies above 1000/ml measured by PCR in plasma was defined as RNAemia and used as surrogate for viremia. In this cohort of 92 patients 59 (64%) were invasively ventilated. RNAemia was found in 31 patients (34%). Hypertension and corticosteroid treatment was more common in patients with RNAemia. Extra-pulmonary organ failure biomarkers and the extent of organ failure were similar in patients with and without RNAemia, but the former group had more renal replacement therapy and higher mortality (26 vs 16%; 35 vs 16%, respectively, p = 0.04). RNAemia was not an independent predictor of death at 30 days after adjustment for age. SARS-CoV2 RNA copies in plasma is a common finding in ICU patients with COVID-19. Although viremia was not associated with extra pulmonary organ failure it was more common in patients who did not survive to 30 days after ICU admission.Trial registration: ClinicalTrials NCT04316884.

Figure 1

SARS-CoV-2 RNA levels in plasma on the ICU day of sampling. Mann–Whitney test was used to compare RNA levels on ICU day 1–2 and ICU day 5–7. The p-value denotes difference in RNA copies from ICU days 1–2 to 5–7.

Figure 2

Odds ratios from logistic regression assessing the association between age, crude and age adjusted RNAemia in plasma, and risk of organ support and death. RNAemia was defined as SARS-CoV-2 RNA copies > 1000/ml plasma. * denotes p < 0.05 for odds ratio.