Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
Clinical Virology Laboratory, Stanford Health Care, Stanford, California, USA.
Clin Infect Dis. 2021 May 4;72(9):e291-e295. doi: 10.1093/cid/ciaa1054.
Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in blood, also known as RNAemia, has been reported, but its prognostic implications are poorly understood. This study aimed to determine the frequency of SARS-CoV-2 RNA in plasma and its association with coronavirus disease 2019 (COVID-19) clinical severity.
An analytical cross-sectional study was performed in a single-center tertiary care institution and included consecutive inpatients and outpatients with confirmed COVID-19. The prevalence of SARS CoV-2 RNAemia and the strength of its association with clinical severity variables were examined and included intensive care unit (ICU) admission, invasive mechanical ventilation, and 30-day all-cause mortality.
Paired nasopharyngeal and plasma samples were included from 85 patients. The median age was 55 years, and individuals with RNAemia were older than those with undetectable SARS-CoV-2 RNA in plasma (63 vs 50 years; P = .04). Comorbidities were frequent including obesity (37.6%), hypertension (30.6%), and diabetes mellitus (22.4%). RNAemia was detected in 28/85 (32.9%) of patients, including 22/28 (78.6%) who required hospitalization. In models adjusted for age, RNAemia was detected more frequently in individuals who developed severe disease including ICU admission (32.1 vs 14.0%; P = .04) and invasive mechanical ventilation (21.4% vs 3.5%; P = .02). All 4 deaths occurred in individuals with detectable RNAemia. An additional 121 plasma samples from 28 individuals with RNAemia were assessed longitudinally, and RNA was detected for a maximum duration of 10 days.
This study demonstrated a high proportion of SARS-CoV-2 RNAemia, and an association between RNAemia and clinical severity suggesting the potential utility of plasma viral testing as a prognostic indicator for COVID-19.
已报道严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）RNA 在血液中的检测，也称为 RNA 血症，但对其预后意义知之甚少。本研究旨在确定血浆中 SARS-CoV-2 RNA 的频率及其与 2019 年冠状病毒病（COVID-19）临床严重程度的关系。
在一家单中心三级保健机构进行了一项分析性横断面研究，纳入了确诊的 COVID-19 连续住院和门诊患者。检查了 SARS-CoV-2 RNA 血症的患病率及其与临床严重程度变量的关联，包括入住重症监护病房（ICU）、有创机械通气和 30 天全因死亡率。
纳入了 85 例患者的鼻咽和血浆配对样本。中位年龄为 55 岁，RNA 血症患者比血浆中无法检测到 SARS-CoV-2 RNA 的患者年龄更大（63 岁比 50 岁；P =.04）。合并症常见，包括肥胖（37.6%）、高血压（30.6%）和糖尿病（22.4%）。85 例患者中有 28 例（32.9%）检测到 RNA 血症，其中 22 例（78.6%）需要住院治疗。在调整年龄的模型中，RNA 血症在发生严重疾病的个体中更常见，包括入住 ICU（32.1%比 14.0%；P =.04）和有创机械通气（21.4%比 3.5%；P =.02）。4 例死亡均发生在可检测到 RNA 血症的患者中。进一步对 28 例 RNA 血症患者的 121 份血浆样本进行了纵向评估，RNA 检测的最长持续时间为 10 天。
本研究显示 SARS-CoV-2 RNA 血症比例较高，RNA 血症与临床严重程度之间存在关联，提示血浆病毒检测作为 COVID-19 预后指标的潜在效用。
