Detectable Serum Severe Acute Respiratory Syndrome Coronavirus 2 Viral Load (RNAemia) Is Closely Correlated With Drastically Elevated Interleukin 6 Level in Critically Ill Patients With Coronavirus Disease 2019
Detectable Serum Severe Acute Respiratory Syndrome Coronavirus 2 Viral Load (RNAemia) Is Closely Correlated With Drastically Elevated Interleukin 6 Level in Critically Ill Patients With Coronavirus Disease 2019
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2019 年冠状病毒病危重患者血清中可检测到的严重急性呼吸系统综合症冠状病毒 2 病毒载量（RNA 血症）与急剧升高的白细胞介素 6 水平密切相关
DOI：
10.1093/cid/ciaa449
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发表时间：
2020-10-15
影响因子：
11.8
通讯作者：
Li, Feng
中科院分区：
文献类型：
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作者：
Chen, Xiaohua;Zhao, Binghong;Li, Feng
背景资料。虽然呼吸道标本中SARS-CoV-2病毒载量的检测已被广泛用于诊断2019年冠状病毒病(新冠肺炎)，但不可否认的是，在一小部分新冠肺炎患者中可以检测到血清SARS-CoV-2核酸(RNA血症)。然而，目前尚不清楚核糖核酸血症检测是否与细胞因子风暴的发生或特定类别的患者相关。本研究纳入了解放军中部战区司令部总医院收治的48例新冠肺炎患者，武汉市定点医院中国。根据国家卫生健康委员会中国发布的《新型冠状病毒肺炎诊疗指南(第六版)》将患者分为3组。收集临床和实验室资料，检测血清病毒载量和白介素6(IL-6)水平。对48例新冠肺炎患者的临床特点分析表明，RNA血症仅见于危重患者，且可反映病情的严重程度。此外，重症患者的炎性细胞因子IL-6水平显著升高，几乎是其他患者的10倍。更重要的是，极高的IL-6水平与核糖核酸血症的检测密切相关(R=0.902)。新冠肺炎患者血清中可检测到的SARS-CoV-2RNA(RNA血症)与IL-6浓度升高和预后不良相关。由于IL-6升高可能是更大的细胞因子风暴的一部分，可能会恶化预后，因此IL-6可能成为具有过度炎症反应的危重患者的潜在治疗靶点。
Background. Although the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load in respiratory specimens has been widely used to diagnose coronavirus disease 2019 (COVID-19), it is undeniable that serum SARS-CoV-2 nucleic acid (RNAemia) could be detected in a fraction of COVID-19 patients. However, it is not clear whether testing for RNAemia is correlated with the occurrence of cytokine storms or with the specific class of patients.Methods. This study enrolled 48 patients with COVID-19 admitted to the General Hospital of Central Theater Command, People's Liberation Army, a designated hospital in Wuhan, China. The patients were divided into 3 groups according to the Diagnosis and Treatment of New Coronavirus Pneumonia (sixth edition) guidelines issued by the National Health Commission of China. Clinical and laboratory data were collected, and the serum viral load and interleukin 6 (IL-6) level were determined.Results. Analysis of clinical characteristics of 48 cases of COVID-19 showed that RNAemia was diagnosed only in the critically ill group and seemed to reflect the severity of the disease. Furthermore, the level of the inflammatory cytokine IL-6 in critically ill patients increased significantly, almost 10 times that in other patients. More importantly, the extremely high IL-6 level was closely correlated with the detection of RNAemia (R = 0.902).Conclusions. Detectable serum SARS-CoV-2 RNA (RNAemia) in patients with COVID-19 was associated with elevated IL-6 concentration and poor prognosis. Because elevated IL-6 may be part of a larger cytokine storm that could worsen outcome, IL-6 could be a potential therapeutic target for critically ill patients with an excessive inflammatory response.