SARS-CoV-2 RNAemia Predicts Clinical Deterioration and Extrapulmonary Complications from COVID-19.
SARS-CoV-2 RNAemia Predicts Clinical Deterioration and Extrapulmonary Complications from COVID-19.
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DOI：
10.1093/cid/ciab394
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发表时间：
2022-01-29
期刊：
影响因子：
--
通讯作者：
Stanford COVID-19 Biobank Study Group
中科院分区：
文献类型：
--
作者：
Ram-Mohan N;Kim D;Zudock EJ;Hashemi MM;Tjandra KC;Rogers AJ;Blish CA;Nadeau KC;Newberry JA;Quinn JV;O'Hara R;Ashley E;Nguyen H;Jiang L;Hung P;Blomkalns AL;Yang S;Stanford COVID-19 Biobank Study Group
人们对 2019 年冠状病毒病 (COVID-19) 疾病严重程度和肺外并发症 (EPC) 的决定因素知之甚少。我们表征了严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) RNA 血症与疾病严重程度、临床恶化和特定 EPC 之间的关系。我们使用定量和数字聚合酶链反应（qPCR 和 dPCR）对 191 名因 COVID-19 到急诊科就诊的患者血浆中的 SARS-CoV-2 RNA 进行定量。我们记录了患者的症状、实验室标志物和临床结果，重点关注一段时间内的氧气需求。我们从一部分患者身上收集了纵向血浆样本。我们使用弹性网络回归描述了 RNAemia 在预测临床严重程度和 EPC 中的作用。在 SARS-CoV-2 阳性患者中，23.0%（191 名患者中的 44 名）通过 dPCR 在血浆中检测到病毒 RNA，而通过 qPCR 检测到这一比例为 1.4%（147 名中的 2 名）。大多数经过连续测量的患者在症状出现后 10 天内出现不可检测的 RNA 血症，在 16 天内达到最大临床严重程度，并在 33 天内症状缓解。最初，RNA 血症患者更有可能表现出严重疾病（比值比，6.72 [95% 置信区间，2.45–19.79]）、疾病严重程度恶化（2.43 [1.07–5.38]）和 EPC（2.81 [1.26–6.36]）。 RNA 载量与最大严重程度相关（r = 0.47 [95% 置信区间，.20–.67]）。 dPCR 在检测 SARS-CoV-2 RNAemia 方面比 qPCR 更敏感，后者是最终 COVID-19 严重程度、需氧量以及 EPC 的有力预测因子。由于许多 COVID-19 疗法都是根据需氧量开始的，因此 RNA 血症可能有助于指导最有可能恶化的患者及早开始适当的治疗。使用数字聚合酶链反应测量 2019 年冠状病毒病患者血浆中的严重急性呼吸综合征冠状病毒 2 RNA，可以预测疾病严重程度、临床恶化和肺外并发症，并可能有助于指导患者分诊和管理。
The determinants of coronavirus disease 2019 (COVID-19) disease severity and extrapulmonary complications (EPCs) are poorly understood. We characterized relationships between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNAemia and disease severity, clinical deterioration, and specific EPCs. We used quantitative and digital polymerase chain reaction (qPCR and dPCR) to quantify SARS-CoV-2 RNA from plasma in 191 patients presenting to the emergency department with COVID-19. We recorded patient symptoms, laboratory markers, and clinical outcomes, with a focus on oxygen requirements over time. We collected longitudinal plasma samples from a subset of patients. We characterized the role of RNAemia in predicting clinical severity and EPCs using elastic net regression. Of SARS-CoV-2–positive patients, 23.0% (44 of 191) had viral RNA detected in plasma by dPCR, compared with 1.4% (2 of 147) by qPCR. Most patients with serial measurements had undetectable RNAemia within 10 days of symptom onset, reached maximum clinical severity within 16 days, and symptom resolution within 33 days. Initially RNAemic patients were more likely to manifest severe disease (odds ratio, 6.72 [95% confidence interval, 2.45–19.79]), worsening of disease severity (2.43 [1.07–5.38]), and EPCs (2.81 [1.26–6.36]). RNA loads were correlated with maximum severity (r = 0.47 [95% confidence interval, .20–.67]). dPCR is more sensitive than qPCR for the detection of SARS-CoV-2 RNAemia, which is a robust predictor of eventual COVID-19 severity and oxygen requirements, as well as EPCs. Because many COVID-19 therapies are initiated on the basis of oxygen requirements, RNAemia on presentation might serve to direct early initiation of appropriate therapies for the patients most likely to deteriorate. Measurement of severe acute respiratory syndrome coronavirus 2 RNA from the plasma of patients with coronavirus disease 2019, using digital polymerase chain reaction, can predict disease severity, clinical deterioration, and extrapulmonary complications and may help guide patient triage and management.
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影响因子：
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DOI：
10.1016/s1386-6532(03)00195-1
发表时间：
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影响因子：
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