1. SARS-CoV-2 viral load in nasopharyngeal swabs is not an independent predictor of unfavorable outcome
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Sonsoles Salto-Alejandre, Judith Berastegui-Cabrera, Pedro Camacho-Martínez, Carmen Infante-Domínguez, Marta Carretero-Ledesma, Juan Carlos Crespo-Rivas, Eduardo Márquez, José Manuel Lomas, Claudio Bueno, Rosario Amaya, José Antonio Lepe, José Miguel Cisneros, Jerónimo Pachón, Elisa Cordero, Javier Sánchez-Céspedes, The Virgen del Rocío Hospital COVID-19 Working Team, Instituto de Salud Carlos III, Ministerio de Economía y Competitividad (España), European Commission, Ministerio de Ciencia, Innovación y Universidades (España), Junta de Andalucía, Salto-Alejandre, Sonsoles, Camacho-Martínez, Pedro, Sánchez-Céspedes, Javier, Salto-Alejandre, Sonsoles [0000-0002-1280-4810], Camacho-Martínez, Pedro [0000-0002-6331-4600], Sánchez-Céspedes, Javier [0000-0003-2707-1979], The Virgen del Rocío Hospital COVID-19 Working Team, [Salto-Alejandre,S, Berastegui-Cabrera,J, Camacho-Martínez,P, Infante-Domínguez,C, Carretero-Ledesma,M, Crespo-Rivas,JC, Lomas,JM, Lepe,JA, Cisneros,JM, Cordero,E, Sánchez-Céspedes,J] Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain. [Salto-Alejandre,S, Pachón,J, Sánchez-Céspedes,J] Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain. [Márquez,E] Medico Surgical Unit of Respiratory Diseases, Virgen del Rocío University Hospital, Seville, Spain. [Bueno,C] Unit of Emergencies, Virgen del Rocío University Hospital, Seville, Spain. [Amaya,R] Intensive Care Unit, Virgen del Rocío University Hospital, Seville, Spain. [Pachón,J, Cordero,E] Department of Medicine, University of Seville, Seville, Spain., Tis work was supported by National Plan R+D+I 2013–2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministry of Economy, Industry, and Competitiveness, Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0009], cofnanced by European Develop ment Regional Fund 'A way to achieve Europe', Operative program Intelligent Growth 2014–2020, and supported by Grants from the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Proyectos de Investigación sobre el SARS-CoV-2 y la enfermedad COVID-19 [COV20/00370, and COV20/00580]. J.S.C. is a researcher belong ing to the program 'Nicolás Monardes' (C-0059-2018), Servicio Andaluz de Salud, Junta de Andalucía, Spain.
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0301 basic medicine ,Male ,Logistic regression ,Severity of Illness Index ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors [Medical Subject Headings] ,law.invention ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,0302 clinical medicine ,Patient Admission ,Carga Viral ,law ,Nasopharynx ,Clinical endpoint ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Persons::Persons::Age Groups::Adult::Aged [Medical Subject Headings] ,Aged, 80 and over ,Multidisciplinary ,Pronóstico ,Middle Aged ,Viral Load ,Prognosis ,Intensive care unit ,Death ,Intensive Care Units ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Health Surveys::Health Status Indicators::Patient Acuity::Severity of Illness Index [Medical Subject Headings] ,Muerte ,Quartile ,COVID-19 Nucleic Acid Testing ,RNA, Viral ,Medicine ,Female ,Viral load ,Adult ,medicine.medical_specialty ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies [Medical Subject Headings] ,Anatomy::Respiratory System::Pharynx::Nasopharynx [Medical Subject Headings] ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Science ,030106 microbiology ,Check Tags::Male [Medical Subject Headings] ,Real-Time Polymerase Chain Reaction ,Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospital Units::Intensive Care Units [Medical Subject Headings] ,Article ,03 medical and health sciences ,Internal medicine ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Follow-Up Studies [Medical Subject Headings] ,Severity of illness ,medicine ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Patient Care::Hospitalization::Patient Admission [Medical Subject Headings] ,Humans ,Chemicals and Drugs::Nucleic Acids, Nucleotides, and Nucleosides::Nucleic Acids::RNA::RNA, Viral [Medical Subject Headings] ,Persons::Persons::Age Groups::Adult [Medical Subject Headings] ,Aged ,business.industry ,SARS-CoV-2 ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Genetic Techniques::Nucleic Acid Amplification Techniques::Polymerase Chain Reaction::Real-Time Polymerase Chain Reaction [Medical Subject Headings] ,COVID-19 ,Persons::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings] ,Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [Medical Subject Headings] ,Check Tags::Female [Medical Subject Headings] ,Risk factors ,Persons::Persons::Age Groups::Adult::Aged::Aged, 80 and over [Medical Subject Headings] ,Viral infection ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Clinical Laboratory Techniques::Microbiological Techniques::Viral Load [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis [Medical Subject Headings] ,business ,Follow-Up Studies - Abstract
The aim was to assess the ability of nasopharyngeal SARS-CoV-2 viral load at first patient’s hospital evaluation to predict unfavorable outcomes. We conducted a prospective cohort study including 321 adult patients with confirmed COVID-19 through RT-PCR in nasopharyngeal swabs. Quantitative Synthetic SARS-CoV-2 RNA cycle threshold values were used to calculate the viral load in log10 copies/mL. Disease severity at the end of follow up was categorized into mild, moderate, and severe. Primary endpoint was a composite of intensive care unit (ICU) admission and/or death (n = 85, 26.4%). Univariable and multivariable logistic regression analyses were performed. Nasopharyngeal SARS-CoV-2 viral load over the second quartile (≥ 7.35 log10 copies/mL, p = 0.003) and second tertile (≥ 8.27 log10 copies/mL, p = 0.01) were associated to unfavorable outcome in the unadjusted logistic regression analysis. However, in the final multivariable analysis, viral load was not independently associated with an unfavorable outcome. Five predictors were independently associated with increased odds of ICU admission and/or death: age ≥ 70 years, SpO2, neutrophils > 7.5 × 103/µL, lactate dehydrogenase ≥ 300 U/L, and C-reactive protein ≥ 100 mg/L. In summary, nasopharyngeal SARS-CoV-2 viral load on admission is generally high in patients with COVID-19, regardless of illness severity, but it cannot be used as an independent predictor of unfavorable clinical outcome., This work was supported by National Plan R+D+I 2013–2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministry of Economy, Industry, and Competitiveness, Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0009]; cofinanced by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014–2020; and supported by Grants from the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Proyectos de Investigación sobre el SARS-CoV-2 y la enfermedad COVID-19 [COV20/00370; COV20/00580]. J.S.C. is a researcher belonging to the program “Nicolás Monardes” (C-0059-2018), Servicio Andaluz de Salud, Junta de Andalucía, Spain.
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- 2021