Detection of SARS-CoV-2 RNA in serum is associated with increased mortality risk in hospitalized COVID-19 patients

COVID-19 has overloaded national health services worldwide. Thus, early identification of patients at risk of poor outcomes is critical. Our objective was to analyse SARS-CoV-2 RNA detection in serum as a severity biomarker in COVID-19. Retrospective observational study including 193 patients admitt...

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Published in:	Scientific reports Vol. 11; no. 1; p. 13134
Main Authors:	Rodríguez-Serrano, Diego A., Roy-Vallejo, Emilia, Zurita Cruz, Nelly D., Martín Ramírez, Alexandra, Rodríguez-García, Sebastián C., Arevalillo-Fernández, Nuria, Galván-Román, José María, Fontán García-Rodrigo, Leticia, Vega-Piris, Lorena, Chicot Llano, Marta, Arribas Méndez, David, González de Marcos, Begoña, Hernando Santos, Julia, Sánchez Azofra, Ana, Ávalos Pérez-Urria, Elena, Rodriguez-Cortes, Pablo, Esparcia, Laura, Marcos-Jimenez, Ana, Sánchez-Alonso, Santiago, Llorente, Irene, Soriano, Joan, Suárez Fernández, Carmen, García-Vicuña, Rosario, Ancochea, Julio, Sanz, Jesús, Muñoz-Calleja, Cecilia, de la Cámara, Rafael, Canabal Berlanga, Alfonso, González-Álvaro, Isidoro, Cardeñoso, Laura
Format:	Journal Article
Language:	English
Published:	London Nature Publishing Group UK 23-06-2021 Nature Publishing Group Nature Portfolio
Subjects:	631/326 692/499 692/53 692/699 Biomarkers C-reactive protein Coronaviruses Correlation coefficient COVID-19 Health risks Humanities and Social Sciences Interleukin 6 Lymphopenia Mortality Mortality risk multidisciplinary Observational studies Oxygenation Procalcitonin Regression analysis Ribonucleic acid RNA Science Science (multidisciplinary) Serum levels Severe acute respiratory syndrome coronavirus 2 Viremia
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Summary:	COVID-19 has overloaded national health services worldwide. Thus, early identification of patients at risk of poor outcomes is critical. Our objective was to analyse SARS-CoV-2 RNA detection in serum as a severity biomarker in COVID-19. Retrospective observational study including 193 patients admitted for COVID-19. Detection of SARS-CoV-2 RNA in serum (viremia) was performed with samples collected at 48–72 h of admission by two techniques from Roche and Thermo Fischer Scientific (TFS). Main outcome variables were mortality and need for ICU admission during hospitalization for COVID-19. Viremia was detected in 50–60% of patients depending on technique. The correlation of Ct in serum between both techniques was good (intraclass correlation coefficient: 0.612; p < 0.001). Patients with viremia were older (p = 0.006), had poorer baseline oxygenation (PaO 2 /FiO 2 ; p < 0.001), more severe lymphopenia (p < 0.001) and higher LDH (p < 0.001), IL-6 (p = 0.021), C-reactive protein (CRP; p = 0.022) and procalcitonin (p = 0.002) serum levels. We defined "relevant viremia" when detection Ct was < 34 with Roche and < 31 for TFS. These thresholds had 95% sensitivity and 35% specificity. Relevant viremia predicted death during hospitalization (OR 9.2 [3.8–22.6] for Roche, OR 10.3 [3.6–29.3] for TFS; p < 0.001). Cox regression models, adjusted by age, sex and Charlson index, identified increased LDH serum levels and relevant viremia (HR = 9.87 [4.13–23.57] for TFS viremia and HR = 7.09 [3.3–14.82] for Roche viremia) as the best markers to predict mortality. Viremia assessment at admission is the most useful biomarker for predicting mortality in COVID-19 patients. Viremia is highly reproducible with two different techniques (TFS and Roche), has a good consistency with other severity biomarkers for COVID-19 and better predictive accuracy.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	2045-2322 2045-2322
DOI:	10.1038/s41598-021-92497-1