SARS-CoV-2 RNAemia with higher nasopharyngeal viral load is strongly associated with severity and mortality in patients with COVID-19

  1. Hitoshi Kawasuji
  2. Yoshitomo Morinaga
  3. Hideki Tani
  4. Yoshihiro Yoshida
  5. Yusuke Taekgoshi
  6. Makito Kaneda
  7. Yushi Murai
  8. Kou Kimoto
  9. Akitoshi Ueno
  10. Yuki Miyajima
  11. Koyomi Kawago
  12. Yasutaka Fukui
  13. Miyuki Kimura
  14. Hiroshi Yamada
  15. Ippei Sakamaki
  16. Yoshihiro Yamamoto
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Abstract

Objective

This study aimed to determine the frequency of SARS-CoV-2 RNA in serum and its association with the clinical severity of COVID-19.

Methods

An analytical cross-sectional study was performed in a single tertiary care hospital and included consecutive patients with confirmed COVID-19. The prevalence of SARS-CoV-2 RNAemia and the strength of its association with clinical severity variables, including required oxygen supplementation, ICU admission, invasive mechanical ventilation, and in-hospital mortality, were examined.

Results

Fifty-six patients were included in the study. The median age was 54.5 years, and individuals with RNAemia were older than those without detectable SARS-CoV-2 RNA in serum (78 vs. 50 years; P = .0013). RNAemia was detected in 19.6% of patients (11/56) and in 1.0% (1/25), 50.0% (6/12), and 100.0% (4/4) of moderate, severe, and critically ill cases, respectively. Patients with RNAemia required more frequent oxygen supplementation (90.0% vs. 13.3%; P < .0001) and ICU admission (81.8% vs. 6.7%; P < .0001) and required invasive mechanical ventilation (27.3% vs. 0.0%; P < .0001). Among patients with RNAemia, the median viral loads of NP swabs that were collected around the same time as the serum were significantly higher in critically ill cases (5.4 Log 10 copies/μL [IQR: 4.2–6.3]) than in moderate–severe cases (2.6 Log 10 copies/μL [1.1–4.5]; P =.030) and were significantly higher in nonsurvivor cases (6.2 Log 10 copies/μL [IQR: 6.0–6.5]) than in survivor cases (3.9 Log 10 copies/μL [1.6–4.6]; P =.045).

Conclusions

This study demonstrated a relatively high proportion of SARS-CoV-2 RNAemia and an association between RNAemia and clinical severity. Moreover, among the patients with RNAemia, the viral loads of NP swabs were correlated with severity and mortality, thus suggesting the potential utility of combining serum testing with NP tests as a prognostic indicator for COVID-19 with a higher quality than each separate test.

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