High Frequency of SARS-CoV-2 RNAemia and Association With Severe Disease.
Identifieur interne : 000542 ( Main/Exploration ); précédent : 000541; suivant : 000543High Frequency of SARS-CoV-2 RNAemia and Association With Severe Disease.
Auteurs : Catherine A. Hogan [États-Unis] ; Bryan A. Stevens [États-Unis] ; Malaya K. Sahoo [États-Unis] ; Chunhong Huang [États-Unis] ; Natasha Garamani [États-Unis] ; Saurabh Gombar [États-Unis] ; Fumiko Yamamoto [États-Unis] ; Kanagavel Murugesan [États-Unis] ; Jason Kurzer [États-Unis] ; James Zehnder [États-Unis] ; Benjamin A. Pinsky [États-Unis]Source :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [ 1537-6591 ] ; 2020.
Abstract
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
DOI: 10.1093/cid/ciaa1054
PubMed: 32965474
PubMed Central: PMC7543277
Affiliations:
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Hogan</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pathology, Stanford University School of Medicine, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation><affiliation wicri:level="2"><nlm:affiliation>Clinical Virology Laboratory, Stanford Health Care, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Clinical Virology Laboratory, Stanford Health Care, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Stevens, Bryan A" sort="Stevens, Bryan A" uniqKey="Stevens B" first="Bryan A" last="Stevens">Bryan A. 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Hogan</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pathology, Stanford University School of Medicine, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation><affiliation wicri:level="2"><nlm:affiliation>Clinical Virology Laboratory, Stanford Health Care, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Clinical Virology Laboratory, Stanford Health Care, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Stevens, Bryan A" sort="Stevens, Bryan A" uniqKey="Stevens B" first="Bryan A" last="Stevens">Bryan A. Stevens</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pathology, Stanford University School of Medicine, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation><affiliation wicri:level="2"><nlm:affiliation>Clinical Virology Laboratory, Stanford Health Care, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Clinical Virology Laboratory, Stanford Health Care, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Sahoo, Malaya K" sort="Sahoo, Malaya K" uniqKey="Sahoo M" first="Malaya K" last="Sahoo">Malaya K. Sahoo</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pathology, Stanford University School of Medicine, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Huang, Chunhong" sort="Huang, Chunhong" uniqKey="Huang C" first="Chunhong" last="Huang">Chunhong Huang</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pathology, Stanford University School of Medicine, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Garamani, Natasha" sort="Garamani, Natasha" uniqKey="Garamani N" first="Natasha" last="Garamani">Natasha Garamani</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pathology, Stanford University School of Medicine, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Gombar, Saurabh" sort="Gombar, Saurabh" uniqKey="Gombar S" first="Saurabh" last="Gombar">Saurabh Gombar</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pathology, Stanford University School of Medicine, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Yamamoto, Fumiko" sort="Yamamoto, Fumiko" uniqKey="Yamamoto F" first="Fumiko" last="Yamamoto">Fumiko Yamamoto</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pathology, Stanford University School of Medicine, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Murugesan, Kanagavel" sort="Murugesan, Kanagavel" uniqKey="Murugesan K" first="Kanagavel" last="Murugesan">Kanagavel Murugesan</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pathology, Stanford University School of Medicine, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Kurzer, Jason" sort="Kurzer, Jason" uniqKey="Kurzer J" first="Jason" last="Kurzer">Jason Kurzer</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pathology, Stanford University School of Medicine, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Zehnder, James" sort="Zehnder, James" uniqKey="Zehnder J" first="James" last="Zehnder">James Zehnder</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pathology, Stanford University School of Medicine, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Pinsky, Benjamin A" sort="Pinsky, Benjamin A" uniqKey="Pinsky B" first="Benjamin A" last="Pinsky">Benjamin A. Pinsky</name><affiliation wicri:level="2"><nlm:affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pathology, Stanford University School of Medicine, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation><affiliation wicri:level="2"><nlm:affiliation>Clinical Virology Laboratory, Stanford Health Care, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Clinical Virology Laboratory, Stanford Health Care, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation><affiliation wicri:level="2"><nlm:affiliation>Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author></analytic><series><title level="j">Clinical infectious diseases : an official publication of the Infectious Diseases Society of America</title><idno type="eISSN">1537-6591</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>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.</p></div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">32965474</PMID><DateRevised><Year>2020</Year><Month>10</Month><Day>09</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1537-6591</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2020</Year><Month>Sep</Month><Day>23</Day></PubDate></JournalIssue><Title>Clinical infectious diseases : an official publication of the Infectious Diseases Society of America</Title><ISOAbbreviation>Clin Infect Dis</ISOAbbreviation></Journal><ArticleTitle>High Frequency of SARS-CoV-2 RNAemia and Association With Severe Disease.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">ciaa1054</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1093/cid/ciaa1054</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">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.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">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.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">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.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">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.</AbstractText><CopyrightInformation>© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Hogan</LastName><ForeName>Catherine A</ForeName><Initials>CA</Initials><AffiliationInfo><Affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Clinical Virology Laboratory, Stanford Health Care, Stanford, California, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Stevens</LastName><ForeName>Bryan A</ForeName><Initials>BA</Initials><AffiliationInfo><Affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Clinical Virology Laboratory, Stanford Health Care, Stanford, California, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sahoo</LastName><ForeName>Malaya K</ForeName><Initials>MK</Initials><AffiliationInfo><Affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Huang</LastName><ForeName>ChunHong</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Garamani</LastName><ForeName>Natasha</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gombar</LastName><ForeName>Saurabh</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yamamoto</LastName><ForeName>Fumiko</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Murugesan</LastName><ForeName>Kanagavel</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kurzer</LastName><ForeName>Jason</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zehnder</LastName><ForeName>James</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pinsky</LastName><ForeName>Benjamin A</ForeName><Initials>BA</Initials><AffiliationInfo><Affiliation>Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Clinical Virology Laboratory, Stanford Health Care, Stanford, California, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>09</Month><Day>23</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Clin Infect Dis</MedlineTA><NlmUniqueID>9203213</NlmUniqueID><ISSNLinking>1058-4838</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">RNAemia</Keyword><Keyword MajorTopicYN="N">SARS-CoV-2</Keyword><Keyword MajorTopicYN="N">blood</Keyword><Keyword MajorTopicYN="N">severity</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>06</Month><Day>09</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>07</Month><Day>27</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>9</Month><Day>23</Day><Hour>12</Hour><Minute>13</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>9</Month><Day>24</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate 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Hogan</name></region><name sortKey="Garamani, Natasha" sort="Garamani, Natasha" uniqKey="Garamani N" first="Natasha" last="Garamani">Natasha Garamani</name><name sortKey="Gombar, Saurabh" sort="Gombar, Saurabh" uniqKey="Gombar S" first="Saurabh" last="Gombar">Saurabh Gombar</name><name sortKey="Hogan, Catherine A" sort="Hogan, Catherine A" uniqKey="Hogan C" first="Catherine A" last="Hogan">Catherine A. Hogan</name><name sortKey="Huang, Chunhong" sort="Huang, Chunhong" uniqKey="Huang C" first="Chunhong" last="Huang">Chunhong Huang</name><name sortKey="Kurzer, Jason" sort="Kurzer, Jason" uniqKey="Kurzer J" first="Jason" last="Kurzer">Jason Kurzer</name><name sortKey="Murugesan, Kanagavel" sort="Murugesan, Kanagavel" uniqKey="Murugesan K" first="Kanagavel" last="Murugesan">Kanagavel Murugesan</name><name sortKey="Pinsky, Benjamin A" sort="Pinsky, Benjamin A" uniqKey="Pinsky B" first="Benjamin A" last="Pinsky">Benjamin A. 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