Can SARS-CoV-2 RNAemia Be Used to Predict COVID-19 Mortality?
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
COVID-19 patients admitted to the ICU
Hospitalized, non-ICU patients with and without COVID-19
SARS-CoV-2-negative ICU sepsis patients
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)
28-day ICU mortality
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
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, PTX3’ (activator of the complement pathway of the innate immune system)
Galectin-3-binding protein (LGALS3BP) identified as interaction partners of SARS-CoV-2 spike glycoprotein
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
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan