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COVID-19 Clinical Outcomes

Can SARS-CoV-2 RNAemia Be Used to Predict COVID-19 Mortality?

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BACKGROUND AND PURPOSE:

  • Highly accurate prognostic markers for patients with COVID-19 admitted to the ICU are currently available
  • Gutmann et al. (Nature Communications, 2021) assessed whether RNAemia (RNA detected in plasma or serum) may be useful as a possible predictive marker for mortality due to COVID-19

METHODS:

  • Participants
    • COVID-19 patients admitted to the ICU
    • Controls
      • Hospitalized, non-ICU patients with and without COVID-19
      • SARS-CoV-2-negative ICU sepsis patients
  • Study design
    • Serum and plasma samples collected within 24 hours of admission to ICU and during week 1, week 2, and before discharge
    • Following lab measurements obtained
      • RNAemia and protein levels
      • Established protein markers of acute respiratory distress syndrome (e.g. PTX3)
  • Primary outcome
    • 28-day ICU mortality

RESULTS:

  • 474 blood samples
    • Hospitalized COVID-19 patients: 123 individuals
    • Non-COVID-19 ICU sepsis patients: 25 individuals
    • Healthy controls: 30 individuals
  • SARS-CoV-2 RNA was detected in plasma or serum of COVID-19 ICU patients
    • Detectable RNAemia within 6 days of admission: 23% of patients
    • RNAemia was more common early after symptom onset
  • RNAemia within 6 days of admission to ICU was more common in non-survivors than survivors
    • Non-survivors: 56%
    • Survivors: 13%
    • P=0.0006
  • RNAemia was associated with a higher risk of 28-day mortality
    • Hazard ratio 2.05 (95% CI, 1.38 to 3.04)
  • RNAemia positive samples had lower anti-SARS-CoV-2 spike IgG levels and lower SARS-CoV-2 neutralization capacity
  • Machine learning identified the following as the best binary signatures associated with 28-day mortality
    • ‘Age, RNAemia’
    • ‘Age, PTX3’ (activator of the complement pathway of the innate immune system)
  • Proteomics data
    • Galectin-3-binding protein (LGALS3BP) identified as interaction partners of SARS-CoV-2 spike glycoprotein

CONCLUSION:

  • RNAemia in COVID-19 ICU patients is associated with an increased risk of mortality
  • Novel protein, LGALS3BP, may have therapeutic implications
  • The authors state

…RNAemia in COVID-19 ICU patients is associated with a higher risk of death, an observation that could potentially be a disease-specific enrichment biomarker for antiviral medications, given the lack of benefit of these drugs in unselected ICU patients with COVID-19

Learn More – Primary Sources:

SARS-CoV-2 RNAemia and proteomic trajectories inform prognostication in COVID-19 patients admitted to intensive care

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Related ObG Topics:

How Many COVID-19 Patients are Also Lupus Anticoagulant Positive?
Can a New Scoring Method Predict Mortality in COVID-19 Patients?
What are the Strongest Predictors of COVID-19 Hospitalization and Critical Illness?
Is Blood Viscosity Greater in Patients with Severe COVID-19?

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