The Impact of Viremia on Organ Failure, Biomarkers and Mortality in a Swedish Cohort of Critically ill COVID-19 Patients

Abstract

BackgroundThe spread of virus via the blood stream has been suggested to contribute to extra pulmonary organ failure in Coronavirus disease 2019 (COVID-19). We assessed SARS-CoV-2 RNAemia (RNAemia) and the association between RNAemia and inflammation, organ failure and mortality in critically ill COVID-19 patients.MethodsIn a tertiary center we included all patients with PCR verified COVID-19 and consent admitted to ICU. SARS-CoV-2 RNA copies above 1000/ml measured by PCR in plasma was defined as RNAemia and used as surrogate for viremia.ResultsOf the 92 patients RNAemia was found in 31 (34%) and RNA in plasma was detected in 63 (58%). Hypertension and corticosteroid treatment was more common in patients with RNAemia . RNAemia levels were higher in patients with RAAS-inhibitor treatment or corticosteroid treatment than those without. Extra-pulmonary organ failure biomarkers and the extent of organ failure were similar in patients with and without RNAemia, but the former group had more renal replacement therapy and higher mortality (26 vs 16%; 35 vs 16%, respectively, p=0.04). RNAemia was not an independent predictor of death at 30 days after adjustment for age. ConclusionSARS-CoV2 RNA copies in plasma is a common finding in ICU patients with COVID-19. Although viremia was not associated with extra pulmonary organ failure it was more common in patients who did not survive to 30 days after ICU admission.Trial registrationClinicalTrials NCT04316884

SARS-CoV-2 RNAaemia predicts clinical deterioration and extrapulmonary complications from COVID-19

“…8,10,23 Reported associations between RNAaemia and extrapulmonary involvement are more varied. 2,24,25 In addition to characterising the temporal dynamics of clinical deterioration, we included a more comprehensive scope of potential confounders than previous studies. 8 We also use cross-validation not only for model selection, but to assess the relative predictability of clinical severity (good, AUROC 0·82), extrapulmonary complications (fair, AUROC 0·73), and RNAaemia itself (poor, AUROC 0·66).…”

“…The association we observed between RNAaemia and EPCs (which we defined conservatively based on diagnoses at discharge, rather than surrogate biomarkers alone), is stronger than in some previous reports. 25 Extrapulmonary injury could result from direct viral toxicity, endothelial cell damage and thromboinflammation, dysregulation of the immune response, or dysregulation of the renin–angiotensin–aldosterone system. 2 Transaminitis, a common hepatobiliary complication we observed in RNAaemic patients, might result from direct hepatocellular injury by SARS-CoV-2, from cytokine storm and hypoxia-associated metabolic derangement, or from drug-induced liver injury (particularly secondary to investigational agents such as remdesivir, lopinavir, and tocilizumab).…”

Removal of COVID-19 Spike Protein, Whole Virus, Exosomes and Exosomal microRNAs by the Hemopurifier® Lectin-Affinity Cartridge in Critically Ill Patients with COVID-19 Infection

“…Post-mortem studies have demonstrated viral dissemination and seeding of organs including the bone marrow, heart, and gastrointestinal tract 19 . In a Swedish cohort of critically ill COVID-19 patients, the presence of viremia was associated with the need for renal replacement therapy and poor clinical outcome 20 .…”