Nasopharyngeal viral load predicts hypoxemia and disease outcome in admitted COVID-19 patients
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RESEARCH LETTER
Open Access
Nasopharyngeal viral load predicts hypoxemia and disease outcome in admitted COVID-19 patients Amir Shlomai1,2†, Haim Ben-Zvi3†, Ahinoam Glusman Bendersky1,2, Noa Shafran1,2, Elad Goldberg2,4*† and Ella H. Sklan5†
Keywords: Viral load, SARS-CoV-2, COVID-19, Hypoxemia
Introduction The SARS-CoV-2 pandemic imposes an unprecedented burden on hospitals treating coronavirus disease 2019 (COVID-19) patients. Thus, clinical parameters accurately predicting disease outcome are needed. Here, we identified a correlation between viral load measured around admission, lung inflammation, and disease outcome. Similarities and differences between related studies are discussed. Methods Viral loads of COVID-19 patients admitted to Rabin Medical Center between March 16 and July 23, 2020, were analyzed (n = 170, females 42%, age 62 (IQR 46– 73), hospitalization length 7.5 days (IQR 3–13)). Clinical and demographic data were collected from the patients’ electronic medical records. Nasopharyngeal samples were collected and transferred to the microbiology laboratory for testing. Quantitative RT-PCR was performed using the Allplex™ 2019-nCoV Assay (Seegene). Presented are Ct values of the nucleocapsid N gene from the first test performed for each patient. Simple linear regression of clinical parameters against * Correspondence: [email protected] † Amir Shlomai and Haim Ben Zvi contributed equally to this work. † Elad Goldberg and Ella H. Sklan are senior authors and contributed equally to this article. 2 The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 4 Department of Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel Full list of author information is available at the end of the article
the viral load was fitted to the data to assess the association between viral and clinical parameters using GraphPad Prism. Adjusted odds ratio (OR) of mechanical ventilation and mortality were calculated for each significant variable with 95% confidence intervals (CI) using SPSS, version 26.
Results Cycle threshold values of the first test performed for all admitted COVID-19 patients were correlated with the patients’ clinical parameters. Among the parameters tested (lowest values of albumin, lymphocyte count, blood oxygen saturation (BOS) and systolic blood pressure, peak levels of lactate dehydrogenase (LDH), Creactive protein (CRP), ferritin, white blood cell count, and fever), only BOSmin (R = 0.07, p = 0.0004) showed significant correlation (Fig. 1). Interestingly, patients’ age was also significantly correlated with viral load (Fig. 1). Non-survivors and mechanically ventilated patients (n = 21) had a significantly higher viral load (8-folds, Ct = 23.43 ± 5.38) compared to surviving non-intubated patients (n = 149, Ct = 29 ± 5.55, t test p < 0.0001, Fig. 2). A multivariate analysis adjusted for age, gender, and BOSmin revealed that low viral load was independently associated with reduced risk for mechanical ventilation and mortality (OR = 0.90, 95% CI 0.81–0.99, p = 0.
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