Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Viral Load on Risk of Intubation and Mortality Among Hospitalized Patients With Coronavirus Disease 2019
Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Viral Load on Risk of Intubation and Mortality Among Hospitalized Patients With Coronavirus Disease 2019
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DOI：
10.1093/cid/ciaa851
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发表时间：
2021-12-01
影响因子：
11.8
通讯作者：
Satlin, Michael J.
中科院分区：
文献类型：
--
作者：
Magleby, Reed;Westblade, Lars F.;Satlin, Michael J.
背景2019冠状病毒病（COVID-19）住院患者经常需要机械通气，死亡率很高。然而，病毒负荷对这些结果的影响尚不清楚。我们对2020年3月30日至2020年4月30日在纽约市2家医院因COVID-19住院的患者进行了一项回顾性队列研究。应用逆转录-聚合酶链反应检测鼻咽拭子样本的循环阈值（Ct）值评估严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）病毒载量。我们比较了高、中、低入院病毒载量患者的特征和结局，并评估了病毒载量是否与插管和住院死亡率独立相关。我们评估了678名COVID-19患者。较高的病毒载量与年龄增加、合并症、吸烟状况和近期化疗相关。高、中和低病毒载量组的住院死亡率分别为35.0%（Ct 30; n = 242）（P <0.001）。高病毒载量患者（29.1%）的插管风险也高于中等病毒载量患者（20.8%）或低病毒载量患者（14.9%; P <0.001）。高病毒载量与死亡率（校正比值比[aOR]，6.05; 95%可信区间[CI]，2.92-12.52）和插管（aOR，2.73; 95%CI，1.68-4.44）独立相关。COVID-19住院患者的SARS-CoV-2病毒载量与插管风险和住院死亡率独立相关。向临床医生提供这些信息可能用于指导患者护理。
Background. Patients hospitalized with coronavirus disease 2019 (COVID-19) frequently require mechanical ventilation and have high mortality rates. However, the impact of viral burden on these outcomes is unknown.Methods. We conducted a retrospective cohort study of patients hospitalized with COVID-19 from 30 March 2020 to 30 April 2020 at 2 hospitals in New York City. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load was assessed using cycle threshold (Ct) values from a reverse transcription-polymerase chain reaction assay applied to nasopharyngeal swab samples. We compared characteristics and outcomes of patients with high, medium, and low admission viral loads and assessed whether viral load was independently associated with intubation and in-hospital mortality.Results. We evaluated 678 patients with COVID-19. Higher viral load was associated with increased age, comorbidities, smoking status, and recent chemotherapy. In-hospital mortality was 35.0% (Ct 30; n = 242) with high, medium, and low viral loads, respectively (P < .001). The risk of intubation was also higher in patients with a high viral load (29.1%) compared with those with a medium (20.8%) or low viral load (14.9%; P < .001). High viral load was independently associated with mortality (adjusted odds ratio [aOR], 6.05; 95% confidence interval [CI], 2.92-12.52) and intubation (aOR, 2.73; 95% CI, 1.68-4.44).Conclusions. Admission SARS-CoV-2 viral load among hospitalized patients with COVID-19 independently correlates with the risk of intubation and in-hospital mortality. Providing this information to clinicians could potentially be used to guide patient care.