TY - JOUR
T1 - Viral load and disease severity in COVID-19
AU - Pawar, Rahul Dnyaneshwar
AU - Balaji, Lakshman
AU - Mehta, Shivani
AU - Cole, Andrew
AU - Liu, Xiaowen
AU - Peradze, Natia
AU - Grossestreuer, Anne Victoria
AU - Issa, Mahmoud Salah
AU - Patel, Parth
AU - Kirby, James Edward
AU - Rowley, Christopher Francis
AU - Berg, Katherine Margaret
AU - Moskowitz, Ari
AU - Donnino, Michael William
N1 - Funding Information:
Dr. Donnino’s effort is supported, in part, by grants from the National Institutes of Health (K24HL127101, R01HL136705, 1R01DK112886, 1R03 AA026093).
Publisher Copyright:
© 2021, Società Italiana di Medicina Interna (SIMI).
PY - 2022/3
Y1 - 2022/3
N2 - The relationship between COVID-19 severity and viral load is unknown. Our objective was to assess the association between viral load and disease severity in COVID-19. In this single center observational study of adults with laboratory confirmed SARS-CoV-2, the first positive in-hospital nasopharyngeal swab was used to calculate the log10 copies/ml [log10 copy number (CN)] of SARS-CoV-2. Four categories based on level of care and modified sequential organ failure assessment score (mSOFA) at time of swab were determined. Median log10CN was compared between different levels of care and mSOFA quartiles. Median log10CN was compared in patients who did and did not receive influenza vaccine, and the correlation between log10CN and D-dimer was examined. We found that of 396 patients, 54.3% were male, and 25% had no major comorbidity. Hospital mortality was 15.7%. Median mSOFA was 2 (IQR 0–3). Median log10CN was 5.5 (IQR 3.3–8.0). Median log10CN was highest in non-intubated ICU patients [6.4 (IQR 4.4–8.1)] and lowest in intubated ICU patients [3.6 (IQR 2.6–6.9)] (p value < 0.01). In adjusted analyses, this difference remained significant [mean difference 1.16 (95% CI 0.18–2.14)]. There was no significant difference in log10CN between other groups in the remaining pairwise comparisons. There was no association between median log10CN and mSOFA in either unadjusted or adjusted analyses or between median log10CN in patients with and without influenza immunization. There was no correlation between log10CN and D-dimer. We conclude, in our cohort, we did not find a clear association between viral load and disease severity in COVID-19 patients. Though viral load was higher in non-intubated ICU patients than in intubated ICU patients there were no other significant differences in viral load by disease severity.
AB - The relationship between COVID-19 severity and viral load is unknown. Our objective was to assess the association between viral load and disease severity in COVID-19. In this single center observational study of adults with laboratory confirmed SARS-CoV-2, the first positive in-hospital nasopharyngeal swab was used to calculate the log10 copies/ml [log10 copy number (CN)] of SARS-CoV-2. Four categories based on level of care and modified sequential organ failure assessment score (mSOFA) at time of swab were determined. Median log10CN was compared between different levels of care and mSOFA quartiles. Median log10CN was compared in patients who did and did not receive influenza vaccine, and the correlation between log10CN and D-dimer was examined. We found that of 396 patients, 54.3% were male, and 25% had no major comorbidity. Hospital mortality was 15.7%. Median mSOFA was 2 (IQR 0–3). Median log10CN was 5.5 (IQR 3.3–8.0). Median log10CN was highest in non-intubated ICU patients [6.4 (IQR 4.4–8.1)] and lowest in intubated ICU patients [3.6 (IQR 2.6–6.9)] (p value < 0.01). In adjusted analyses, this difference remained significant [mean difference 1.16 (95% CI 0.18–2.14)]. There was no significant difference in log10CN between other groups in the remaining pairwise comparisons. There was no association between median log10CN and mSOFA in either unadjusted or adjusted analyses or between median log10CN in patients with and without influenza immunization. There was no correlation between log10CN and D-dimer. We conclude, in our cohort, we did not find a clear association between viral load and disease severity in COVID-19 patients. Though viral load was higher in non-intubated ICU patients than in intubated ICU patients there were no other significant differences in viral load by disease severity.
KW - COVID-19
KW - Coronavirus
KW - Organ dysfunction score
KW - RT-PCR
KW - SARS-CoV-2
KW - Viral load
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UR - http://www.scopus.com/inward/citedby.url?scp=85108178766&partnerID=8YFLogxK
U2 - 10.1007/s11739-021-02786-w
DO - 10.1007/s11739-021-02786-w
M3 - Article
C2 - 34133005
AN - SCOPUS:85108178766
SN - 1828-0447
VL - 17
SP - 359
EP - 367
JO - Internal and Emergency Medicine
JF - Internal and Emergency Medicine
IS - 2
ER -
