SARS-CoV-2 Viremia is Associated with COVID-19 Severity and Predicts Clinical Outcomes.
| dc.contributor.author | Jacobs, Jana L | |
| dc.contributor.author | Bain, William | |
| dc.contributor.author | Naqvi, Asma | |
| dc.contributor.author | Staines, Brittany | |
| dc.contributor.author | Castanha, Priscila MS | |
| dc.contributor.author | Yang, Haopu | |
| dc.contributor.author | Boltz, Valerie F | |
| dc.contributor.author | Barratt-Boyes, Simon | |
| dc.contributor.author | Marques, Ernesto TA | |
| dc.contributor.author | Mitchell, Stephanie L | |
| dc.contributor.author | Methé, Barbara | |
| dc.contributor.author | Olonisakin, Tolani F | |
| dc.contributor.author | Haidar, Ghady | |
| dc.contributor.author | Burke, Thomas W | |
| dc.contributor.author | Petzold, Elizabeth | |
| dc.contributor.author | Denny, Thomas | |
| dc.contributor.author | Woods, Chris W | |
| dc.contributor.author | McVerry, Bryan J | |
| dc.contributor.author | Lee, Janet S | |
| dc.contributor.author | Watkins, Simon C | |
| dc.contributor.author | St Croix, Claudette M | |
| dc.contributor.author | Morris, Alison | |
| dc.contributor.author | Kearney, Mary F | |
| dc.contributor.author | Ladinsky, Mark S | |
| dc.contributor.author | Bjorkman, Pamela J | |
| dc.contributor.author | Kitsios, Georgios D | |
| dc.contributor.author | Mellors, John W | |
| dc.date.accessioned | 2022-05-03T18:51:35Z | |
| dc.date.available | 2022-05-03T18:51:35Z | |
| dc.date.issued | 2021-08-10 | |
| dc.date.updated | 2022-05-03T18:51:33Z | |
| dc.description.abstract | BackgroundSARS-CoV-2 viral RNA (vRNA) is detected in the bloodstream of some patients with COVID-19 ("RNAemia") but it is not clear whether this RNAemia reflects viremia (i.e., virus particles) and how RNAemia/viremia is related to host immune responses and outcomes.MethodsSARS-CoV-2 vRNA was quantified by ultra-sensitive RT-PCR in plasma samples (0.5-1.0 ml) from observational cohorts of 51 COVID-19 patients including 9 outpatients, 19 hospitalized (non-ICU), and 23 ICU patients, and vRNA levels compared with cross-sectional indices of COVID-19 severity and prospective clinical outcomes. We used multiple imaging methods to visualize virions in pelleted plasma.ResultsSARS-CoV-2 vRNA was detected in plasma of 100%, 52.6% and 11.1% of ICU, non-ICU, and outpatients respectively. Virions were detected in plasma pellets by electron tomography and immunostaining. Plasma vRNA levels were significantly higher in ICU > non-ICU > outpatients (p<0.0001); and for inpatient, plasma vRNA levels were strongly associated with higher WHO score at admission (p=0.01), maximum WHO score (p=0.002) and discharge disposition (p=0.004). A plasma vRNA level >6,000 copies/ml was strongly associated with mortality (HR: 10.7). Levels of vRNA were significantly associated with several inflammatory biomarkers (p<0.01) but not with plasma neutralizing antibody titers (p=0.8).ConclusionsVisualization of virus particles in plasma indicates that SARS-CoV-2 RNAemia is due, at least in part, to viremia. The levels of SARS-CoV-2 RNAemia quantified by ultrasensitive RT-PCR correlate strongly with disease severity, patient outcome and specific inflammatory biomarkers but not neutralizing antibody titers. | |
| dc.identifier | 6347519 | |
| dc.identifier.issn | 1058-4838 | |
| dc.identifier.issn | 1537-6591 | |
| dc.identifier.uri | ||
| dc.language | eng | |
| dc.publisher | Oxford University Press (OUP) | |
| dc.relation.ispartof | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America | |
| dc.relation.isversionof | 10.1093/cid/ciab686 | |
| dc.subject | COVID-19 outcome | |
| dc.subject | SARS-CoV-2 RNAemia | |
| dc.subject | SARS-CoV-2 viremia | |
| dc.title | SARS-CoV-2 Viremia is Associated with COVID-19 Severity and Predicts Clinical Outcomes. | |
| dc.type | Journal article | |
| duke.contributor.orcid | Woods, Chris W|0000-0001-7240-2453 | |
| pubs.organisational-group | Duke | |
| pubs.organisational-group | School of Medicine | |
| pubs.organisational-group | Staff | |
| pubs.organisational-group | Clinical Science Departments | |
| pubs.organisational-group | Institutes and Centers | |
| pubs.organisational-group | Medicine | |
| pubs.organisational-group | Medicine, Duke Human Vaccine Institute | |
| pubs.organisational-group | Duke Human Vaccine Institute | |
| pubs.organisational-group | Institutes and Provost's Academic Units | |
| pubs.organisational-group | University Institutes and Centers | |
| pubs.organisational-group | Duke Global Health Institute | |
| pubs.publication-status | Published |