1. Effect of viral storm in patients admitted to intensive care units with severe COVID-19 in Spain: a multicentre, prospective, cohort study
- Author
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Jesús F Bermejo-Martin, Nadia García-Mateo, Anna Motos, Salvador Resino, Luis Tamayo, Pablo Ryan Murua, Elena Bustamante-Munguira, Elena Gallego Curto, Alejandro Úbeda-Iglesias, María del Carmen de la Torre, Ángel Estella, Sandra Campos-Fernández, Ignacio Martínez Varela, Felipe Pérez-García, Lorenzo Socias, Juan López Messa, Pablo Vidal-Cortés, Víctor Sagredo Meneses, Milagros González-Rivera, Nieves Carbonell, David de Gonzalo-Calvo, María Cruz Martín Delgado, Luis Jorge Valdivia, Caridad Martín-López, Ruth Noemí Jorge García, Emilio Maseda, Ana Loza-Vázquez, David J Kelvin, Ferrán Barbé, Antoni Torres, Alicia Ortega, Amanda de la Fuente, Raquel Almansa, Tamara Postigo, Noelia Jorge, Ana P Tedim, Laura González-González, Lara Sánchez Recio, Wysali Trapiello, José Ángel Berezo, Rubén Herrán-Monge, Jesús Blanco, Pedro Enríquez, Isidoro Martínez, María Martín-Vicente, María José Muñoz-Gómez, Vicente Más, Mónica Vázquez, Olga Cano, Amalia Martínez de la Gándara, Covadonga Rodríguez, Gloria Andrade, Gloria Renedo, Juan Bustamante-Munguira, Ramón Cicuendez Ávila, María Salgado-Villén, Enrique Berruguilla-Pérez, Estel Güell, Fernando Javier Casadiego Monachello, María Recuerda Núñez, Juan Manuel Sánchez Calvo, Yhivian Peñasco-Martín, María Teresa García Unzueta, Adrián Ceccato, Laia Fernández-Barat, María Teresa Bouza Vieiro, Ana Moreno-Romero, Leire Pérez Bastida, Lorena del Río-Carbajo, Noelia Albalá Martínez, José Manuel Gómez, María Luisa Blasco, Jesús Caballero, Carme Barberà, Jessica González, María Teresa Nieto, Jorge Nieto-del Olmo, Estefanía Prol-Silva, Joan Canseco-Ribas, Jose María Eiros, Instituto de Salud Carlos III, Canadian Institutes of Health Research, Li Ka Shing Foundation, European Society of Clinical Microbiology and Infectious Diseases, Centro de Investigación Biomédica en Red - CIBERES (Enfermedades Respiratorias), Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), and Unión Europea. Fondo Social Europeo (ESF/FSE)
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Microbiology (medical) ,Infectious Diseases ,Spain ,Virology ,COVID-19 ,Microbiology - Abstract
Background: The contribution of the virus to the pathogenesis of severe COVID-19 is still unclear. We aimed to evaluate associations between viral RNA load in plasma and host response, complications, and deaths in critically ill patients with COVID-19. Methods: We did a prospective cohort study across 23 hospitals in Spain. We included patients aged 18 years or older with laboratory-confirmed SARS-CoV-2 infection who were admitted to an intensive care unit between March 16, 2020, and Feb 27, 2021. RNA of the SARS-CoV-2 nucleocapsid region 1 (N1) was quantified in plasma samples collected from patients in the first 48 h following admission, using digital PCR. Patients were grouped on the basis of N1 quantity: VIR-N1-Zero (2747 N1 copies per mL). The primary outcome was all-cause death within 90 days after admission. We evaluated odds ratios (ORs) for the primary outcome between groups using a logistic regression analysis. Findings: 1068 patients met the inclusion criteria, of whom 117 had insufficient plasma samples and 115 had key information missing. 836 patients were included in the analysis, of whom 403 (48%) were in the VIR-N1-Low group, 283 (34%) were in the VIR-N1-Storm group, and 150 (18%) were in the VIR-N1-Zero group. Overall, patients in the VIR-N1-Storm group had the most severe disease: 266 (94%) of 283 patients received invasive mechanical ventilation (IMV), 116 (41%) developed acute kidney injury, 180 (65%) had secondary infections, and 148 (52%) died within 90 days. Patients in the VIR-N1-Zero group had the least severe disease: 81 (54%) of 150 received IMV, 34 (23%) developed acute kidney injury, 47 (32%) had secondary infections, and 26 (17%) died within 90 days (OR for death 0·30, 95% CI 0·16-0·55; p
- Published
- 2023