Journal
CLINICAL INFECTIOUS DISEASES
Volume 73, Issue 11, Pages E4197-E4205Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciaa851
Keywords
SARS-CoV-2; coronavirus disease 2019; viral load; hospitalized patients; outcomes
Categories
Funding
- National Center for Advancing Translational Science at the National Institutes of Health [UL1 TR002384]
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This study found that the admission SARS-CoV-2 viral load among hospitalized patients with COVID-19 is independently associated with the risk of intubation and in-hospital mortality, with higher viral loads linked to increased mortality and intubation risk.
Background. Patients hospitalized with coronavirus disease 2019 (COVID-19) frequently require mechanical ventilation and have high mortality rates. However, the impact of viral burden on these outcomes is unknown. Methods. We conducted a retrospective cohort study of patients hospitalized with COVID-19 from 30 March 2020 to 30 April 2020 at 2 hospitals in New York City. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load was assessed using cycle threshold (Ct) values from a reverse transcription-polymerase chain reaction assay applied to nasopharyngeal swab samples. We compared characteristics and outcomes of patients with high, medium, and low admission viral loads and assessed whether viral load was independently associated with intubation and in-hospital mortality. Results. We evaluated 678 patients with COVID-19. Higher viral load was associated with increased age, comorbidities, smoking status, and recent chemotherapy. In-hospital mortality was 35.0% (Ct <25; n = 220), 17.6% (Ct 25-30; n = 216), and 6.2% (Ct >30; n = 242) with high, medium, and low viral loads, respectively (P < .001). The risk of intubation was also higher in patients with a high viral load (29.1%) compared with those with a medium (20.8%) or low viral load (14.9%; P < .001). High viral load was independently associated with mortality (adjusted odds ratio [aOR], 6.05; 95% confidence interval [CI], 2.92-12.52) and intubation (aOR, 2.73; 95% CI, 1.68-4.44). Conclusions. Admission SARS-CoV-2 viral load among hospitalized patients with COVID-19 independently correlates with the risk of intubation and in-hospital mortality. Providing this information to clinicians could potentially be used to guide patient care.
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