Journal
SCIENTIFIC REPORTS
Volume 11, Issue 1, Pages -Publisher
NATURE PORTFOLIO
DOI: 10.1038/s41598-021-92497-1
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Funding
- Fondos Supera COVID19 by Banco Santander
- Spanish MINECO and Instituto de Salud Carlos III [RD16/0011/0012, PI18/0371]
- European Regional Development Fund (ERDF) A way to make Europe
- Community of Madrid through the Covid 2019 Aid
- Ministerio de Economia y Competitividad (Instituto de Salud Carlos III) [CM19/00149]
- Fundacion Espanola de Reumatologia
- CRUE
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The study analyzed SARS-CoV-2 RNA detection in serum as a severity biomarker in COVID-19 patients. Viremia assessment at admission is the most useful biomarker for predicting mortality in 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 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 (PaO2/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.
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