Prenatal Diagnosis Center, Department of Clinical Laboratory, Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, China.
J Med Virol. 2021 May;93(5):3165-3175. doi: 10.1002/jmv.26876. Epub 2021 Mar 1.
The disease spectrum of coronavirus disease 2019 (COVID-19) varies from asymptomatic infection to critical illness and death. Identification of prognostic markers is vital for predicting progression and clinical practice. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, known as RNAemia, has been detected in the blood. However, the potential clinical value of SARS-CoV-2 RNAemia remains unknown. We, therefore, conducted a meta-analysis using a random-effects model to estimate the pooled prevalence of SARS-CoV-2 RNAemia as well as summary strength of RNAemia in association with disease severity and unfavorable clinical outcomes. A total of 21 studies involving 2181 patients were included. SARS-CoV-2 RNAemia in COVID-19 patients varied from 9.4% to 74.1%, with a pooled estimate of 34% (95% confidene interval [CI]: 26%-43%). Overall, SARS-CoV-2 RNAemia was associated with COVID-19 severity with odds ratio (OR) of 5.43 (95% CI: 3.46-8.53). In addition, SARS-CoV-2 RNAemia was a significant risk factor for unfavorable clinical outcomes (OR = 6.54, 95% CI: 3.82-11.21). The summary OR was 4.28 (95% CI: 2.20-8.33) for intensive care unit (ICU) admission, 11.07 (95% CI: 5.60-21.88) for mortality. Furthermore, RNAemia was also a significant risk factor for invasive mechanical ventilation and multiple organ failure. SARS-CoV-2 RNAemia is associated with disease severity, ICU admission, death in COVID-19, and may serve as a clinical predictor. More prospective trials in evaluating the potential of SARS-CoV-2 RNAemia as a prognostic indicator are necessary.
新型冠状病毒疾病 2019（COVID-19）的疾病谱从无症状感染到重症和死亡不等。识别预后标志物对于预测疾病进展和临床实践至关重要。严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）RNA，称为 RNAemia，已在血液中检测到。然而，SARS-CoV-2 RNAemia 的潜在临床价值尚不清楚。因此，我们使用随机效应模型进行了荟萃分析，以估计 SARS-CoV-2 RNAemia 的汇总患病率，以及 RNAemia 与疾病严重程度和不良临床结局的关联的汇总强度。共纳入了 21 项涉及 2181 名患者的研究。COVID-19 患者的 SARS-CoV-2 RNAemia 从 9.4%到 74.1%不等，汇总估计值为 34%（95%置信区间[CI]：26%-43%）。总体而言，SARS-CoV-2 RNAemia 与 COVID-19 严重程度相关，比值比（OR）为 5.43（95%CI：3.46-8.53）。此外，SARS-CoV-2 RNAemia 是不良临床结局的重要危险因素（OR=6.54，95%CI：3.82-11.21）。对于入住重症监护病房（ICU）的汇总 OR 为 4.28（95%CI：2.20-8.33），死亡率为 11.07（95%CI：5.60-21.88）。此外，RNAemia 也是有创机械通气和多器官衰竭的重要危险因素。SARS-CoV-2 RNAemia 与 COVID-19 的疾病严重程度、入住 ICU、死亡相关，可能作为临床预测指标。需要更多评估 SARS-CoV-2 RNAemia 作为预后指标的潜在价值的前瞻性试验。
