ORIGINAL ARTICLE   

Panminerva Medica 2022 December;64(4):465-71

DOI: 10.23736/S0031-0808.22.04705-X

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Baseline plasma SARS-CoV-2 RNA detection predicts an adverse COVID-19 evolution in moderate to severe hospitalized patients

Manuela RIZZI ¹, Filippo PATRUCCO ^{2, 3}, Morena TREVISAN ⁴, Giulia FAOLOTTO ⁴, Alessio MERCANDINO ⁴, Chiara STROLA ⁴, Paolo RAVANINI ⁴, Martina COSTANZO ^{3, 5, 6}, Stelvio TONELLO ^{3, 7}, Erica MATINO ^{3, 5, 6}, Giuseppe F. CASCIARO ^{3, 5, 6}, Alessandro CROCE ^{3, 5, 6}, Eleonora RIZZI ^{3, 5, 6}, Erika ZECCA ^{3, 5, 6}, Anita PEDRINELLI ^{3, 5, 6}, Veronica VASSIA ^{3, 5, 6}, Raffaella LANDI ^{3, 5, 6}, Mattia BELLAN ^{1, 3, 5, 6, 7}, Luigi M. CASTELLO ^{3, 8}, Rosalba MINISINI ³, Venkata R. MALLELA ¹, Gian C. AVANZI ^{3, 6}, Mario PIRISI ^{3, 5, 6, 7}, Daniele LILLERI ⁹, Paolo SOLIDORO ^{10, 11}, Francesco GAVELLI ^{3, 6} ✉, Pier P. SAINAGHI ^{1, 3, 5, 6, 7}

¹ Unit of Rheumatology, Maggiore della Carità University Hospital, Novara, Italy; ² Division of Respiratory Diseases, Department of Medicine, Maggiore della Carità University Hospital, Novara, Italy; ³ Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy; ⁴ Unit of Microbiology and Virology, Department of Laboratory Medicine, Maggiore della Carità University Hospital, Novara, Italy; ⁵ COVID-19 Unit, Department of Internal Medicine, Maggiore della Carità University Hospital, Novara, Italy; ⁶ COVID-19 Sub-Intensive Unit, Division of Emergency Medicine, Maggiore della Carità University Hospital, Novara, Italy; ⁷ Center for Autoimmune and Allergic Diseases (CAAD), University of Eastern Piedmont, Novara, Italy; ⁸ Division of Internal Medicine, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy; ⁹ Unit of Microbiology and Virology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; ¹⁰ Unit of Respiratory Diseases, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; ¹¹ Department of Medical Sciences, University of Turin, Turin, Italy

BACKGROUND: SARS-CoV-2 is a single-stranded RNA virus, known to be the causative agent of COVID-19. As the resulting disease shows a very heterogeneous range of clinical manifestations, the identification of early biomarkers allowing patients stratification according to the expected disease severity is still an unmet clinical need.
METHODS: In this observational prospective cohort study, 137 consecutive patients, testing positive for SARS-CoV-2 infection by nasopharyngeal swab RT-PCR or antigenic test, were enrolled to evaluate their plasma viral load at the time of hospitalization.
RESULTS: Even if all of them had a molecular diagnosis of COVID-19, only 29 patients showed a detectable plasma SARS-CoV-2 RNAemia. Such viremic patients also showed other clinical and laboratory finding alterations (increased troponin I, IL-6, RDW-CV, and creatinine levels along with decreased platelet count and glomerular filtration rate). A plasma detectable RNA viral load predicted in hospital death or ICU admission with an odds ratio of 3.53 (CI: 1.44-8.64, P=0.0058), while the lack of a detectable viral load was associated with a faster recovery, with an odds ratio of 4.06 (CI: 1.72-9.59, P=0.0014). These findings were confirmed in multivariate models including age, sex and baseline National Early Warning Score 2 and arterial oxygen tension over inspired oxygen fraction ratio.
CONCLUSIONS: Our data thus suggest that plasma viral RNA load at the time of hospital admission could represent a useful independent biomarker allowing early patients’ stratification according to the expected disease evolution, and driving clinical decisions tailored on the specific needs of the individual patient.

KEY WORDS: SARS-CoV-2; COVID-19; RNA