Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, North Garden Rd. 49, Haidian District, Beijing, 100191, China.
Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing, 100191, China.
Virol J. 2024 Oct 7;21(1):247. doi: 10.1186/s12985-024-02526-4.
SARS-CoV-2 viremia is associated with disease severity and high risk for in-hospital mortality. However, the impact of SARS-CoV-2 viremia on long-term outcomes in hospitalized patients with COVID-19 is poorly understood.
We conducted a prospective cohort study and recruited a group of older adult patients with COVID-19 admitted to pulmonary intermediate care units of Peking University Third Hospital during December 2022 and January 2023. The plasma level of SARS-CoV-2 RNA was determined by a standardized RT-PCR technique, and SARS-CoV-2 RNAemia was defined as a plasma viral load ≥ 50 copies/ml. In-hospital and follow-up (180-day) outcome data were collected.
A total of 101 patients with an average of 80.4 years were recruited, and 63.4% of them were severe or very severe cases. Twenty-eight patients (27.7%) had SARS-CoV-2 RNAemia, with a median viral RNA load of 422.1 [261.3, 1085.6] copies/ml. Patients with SARS-CoV-2 RNAemia were more likely to develop critical cases and had a higher incidence of sepsis. Accordingly, they had a higher 180-day mortality (57.1% vs. 19.7%, P < 0.001), as well as in-hospital mortality (50.0% vs. 13.7%, P < 0.001), independent of age, disease severity, sepsis, lymphocyte count and C-Reactive protein. In addition, the risk for 180-day mortality increased with the SARS-CoV-2 RNA load in plasma. Plasma cytokines, including IL-6, IL-8 and IL-10, were higher in patients with SARS-CoV-2 RNAemia.
Our study indicates that SARS-CoV-2 RNAemia serves as a useful biomarker for predicting mortality, especially long-term mortality, in older adult patients hospitalized in pulmonary intermediate care units.
Chinese Clinical Trial Registry website (No. ChiCTR2300067434).
SARS-CoV-2 病毒血症与疾病严重程度和院内死亡率高相关。然而，SARS-CoV-2 病毒血症对 COVID-19 住院患者的长期结局的影响知之甚少。
我们进行了一项前瞻性队列研究，招募了一组 2022 年 12 月至 2023 年 1 月期间北京大学第三医院肺部中级护理病房收治的老年 COVID-19 患者。采用标准化 RT-PCR 技术测定 SARS-CoV-2 RNA 血浆水平，SARS-CoV-2 RNA 血症定义为血浆病毒载量≥50 拷贝/ml。收集住院和随访（180 天）结局数据。
共纳入 101 例患者，平均年龄 80.4 岁，其中 63.4%为重症或极重症病例。28 例（27.7%）患者存在 SARS-CoV-2 RNA 血症，中位病毒 RNA 载量为 422.1[261.3，1085.6]拷贝/ml。SARS-CoV-2 RNA 血症患者更易发生危重症病例，且脓毒症发生率更高。因此，他们的 180 天死亡率（57.1%比 19.7%，P<0.001）和住院死亡率（50.0%比 13.7%，P<0.001）更高，与年龄、疾病严重程度、脓毒症、淋巴细胞计数和 C 反应蛋白无关。此外，随着血浆中 SARS-CoV-2 RNA 载量的增加，180 天死亡风险增加。SARS-CoV-2 RNA 血症患者的血浆细胞因子，包括白细胞介素 6、白细胞介素 8 和白细胞介素 10，更高。
我们的研究表明，SARS-CoV-2 RNA 血症可作为预测老年患者住院期间死亡率，特别是长期死亡率的有用生物标志物。
中国临床试验注册中心网站（注册号 ChiCTR2300067434）。
