Journal
PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA
Volume 118, Issue 8, Pages -Publisher
NATL ACAD SCIENCES
DOI: 10.1073/pnas.2017962118
Keywords
SARS-CoV-2; viral dynamics mortality
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Funding
- National Research Agency (ANR) through the ANR-Flash call for COVID-19 [ANR-20-COVI-0018]
- Bill and Melinda Gates Foundation [INV-017335]
- REACTing consortium
- French Ministry of Health [PHRC 20-0424]
- Agence Nationale de la Recherche (ANR) [ANR-20-COVI-0018] Funding Source: Agence Nationale de la Recherche (ANR)
- Bill and Melinda Gates Foundation [INV-017335] Funding Source: Bill and Melinda Gates Foundation
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The study found that age ≥ 65 years, male gender, and chronic pulmonary disease were risk factors associated with mortality from COVID-19. Viral dynamics post-infection independently predicted mortality risk, and pharmacological interventions could shorten time to viral clearance, reducing mortality rates.
The characterization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral kinetics in hospitalized patients and its association with mortality is unknown. We analyzed death and nasopharyngeal viral kinetics in 655 hospitalized patients from the prospective French COVID cohort. The model predicted a median peak viral load that coincided with symptom onset. Patients with age >= 65 y had a smaller loss rate of infected cells, leading to a delayed median time to viral clearance occurring 16 d after symptom onset as compared to 13 d in younger patients (P < 10(-4)). In multivariate analysis, the risk factors associated with mortality were age >= 65 y, male gender, and presence of chronic pulmonary disease (hazard ratio [HR] > 2.0). Using a joint model, viral dynamics after hospital admission was an independent predictor of mortality (HR = 1.31, P < 10-3). Finally, we used our model to simulate the effects of effective pharmacological interventions on time to viral clearance and mortality. A treatment able to reduce viral production by 90% upon hospital admission would shorten the time to viral clearance by 2.0 and 2.9 d in patients of age <65 y and >= 65 y, respectively. Assuming that the association between viral dynamics and mortality would remain similar to that observed in our population, this could translate into a reduction of mortality from 19 to 14% in patients of age >= 65 y with risk factors. Our results show that viral dynamics is associated with mortality in hospitalized patients. Strategies aiming to reduce viral load could have an effect on mortality rate in this population.
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