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

作者：N. Ram-Mohan, David Kim, Elizabeth J Zudock, Marjan M. Hashemi, Kristel C. Tjandra, Angela J. Rogers, C. Blish, K. Nadeau, J. Newberry, James V Quinn, R. O’Hara, Euan A. Ashley, Hien H. Nguyen, Lingxi Jiang, Paul Hung, Andra L Blomkalns, Samuel Yang, Rosen Mann, Anita Visweswaran, T. Ranganath, J. Roque, M. Manohar, H. Din, Komal Kumar, Kathryn Jee, Brigit Noon, Jill Anderson, Bethany Fay, D. Schreiber, Nancy Q. Zhao, Rosemary Vergara, J. McKechnie, Aaron J. Wilk, L. de la Parte, K. Dantzler, Maureen Ty, Nimish D Kathale, A. Rustagi, Giovanny J. Martínez-Colón, Geoffrey T. Ivison, Ruoxi Pi, Madeline J. Lee, Rachel A. Brewer, Taylor Hollis, Andrea Baird, M. Ugur, Drina Bogusch, G. Nahass, K. Haider, K. Q. Tran, L. Simpson, M. Tal, Iris Chang, E. Do, Andrea Fernandes, Alexandra S. Lee, Neera Ahuja, T. Snow, James W. Krempski · 发表于：Clinical Infectious Diseases · 年份：2021 · DOI：10.1093/cid/ciab394 · 被引用次数：47 · 研究领域：Medicine

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 d...