RNAemia and Clinical Outcome in COVID-19 Patients

Jyotsna Agarwal; Vikramjeet Singh; Jaya Garg; Ritu Karoli2; Swasti Tiwari; Shareh Naqvi; Anupam Das; Manodeep Sen

doi:10.5799/jmid.993839

RNAemia and Clinical Outcome in COVID-19 Patients

Abstract

Objectives: Objectives: SARS-CoV-2 virus dynamics in the human body and its correlation with disease severity and biomarkers have not been elucidated. This study aims to evaluate the viral load in the blood sample of COVID-19 patients and viral load association with disease severity and progression. Methods: Blood samples from COVID-19 positive inpatients were collected sequentially, at admission, and during hospitalization. Depending on the clinical presentation, the patients were classified into mild, moderate, and severe categories. The blood samples were subjected to SARS-CoV-2 Real-time polymerase chain reaction (RT-PCR); positive samples were then tested for viral load using digital drop RT-PCR. Patients were followed up until they were discharged. Results: Of 83 enrolled patients, 15 (18.1%) were mild, 45 (54%) were moderate, and 23 (27.7%) had severe symptoms. The blood PCR in 21 patients was positive (rate was 25.3); one was mild, four moderate, and 16 severe on the day of admission. The mean cycle threshold (CT) of RNAemia in these 21 patients was 24.7+3.1. The viral load was significantly higher in patients with severe symptoms than others. Serum ferritin, D-dimer, and plasma fibrinogen were found raised along with lymphopenia in all patients. Viremia was found persistently detectable (or even rising) in patients in the severe category and associated with a fatal outcome. Conclusion: A prolonged elevation of D-dimer, serum ferritin, and plasma fibrinogen together with lymphopenia lead to a greater risk of mortality and morbidity. Quantitative estimation of virus in blood has a clinical significance which may help in prognostication and management of patients of COVID-19. J Microbiol Infect Dis 2021; 11(3):116-123.

Keywords

References

1. Peng L, Liu J, XuW, et al. SARS-CoV-2 can be detected in urine, blood, anal swabs, and oropharyngeal swabs specimens. J Med Virol 2020; 92 (9): 1676-1680. https://doi.org/10.1002/jmv.25936. 2. Chen JH-K, Yip CC-Y, Poon RW-S, et al. Evaluating the use of posterior oropharyngeal saliva in a point-of-care assay for the detection of SARS-CoV-2. Emerg Microbes Infect 2020;9(1):1–14. https://doi.org/10.1080/22221751.2020.1775133.
3. Pan Y, Zhang D, Yang P, Poon LLM, Wang Q. Viral load of SARS-CoV-2 in clinical samples. Lancet Infect Dis.2020;20(4):411–2. https://doi.org/10.1016/S1473-3099(20)30113-4 4. Wang W, XuY, Gao R, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA.2020; 323(18) :1843–4. https://doi.org/10.1001/jama.2020.3786 5. Graham TGW, Dugast-Darzacq C, Dailey GM, et al. Open-source RNA extraction and RTqPCR methods for SARS-CoV-2 detection. PLOS ONE. 2021 16(2): e0246647. https://doi.org/10.1371/journal.pone.0246647
6. Clinical management protocol for COVID-19. https://www.mohfw.gov.in/pdf/Updated ClinicalManagementProtocolforCOVID19dated03072020.pdf (accessed on December 29, 2020).
7. Bangash MN, Patel J, Parekh D. COVID-19 and the liver: little cause for concern. Lancet Gastroenterol Hepatol 2020; 5(6):529-530. https://doi.org/10.1016/S2468-1253(20)30084-4.
8. Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020; 395(10229):1033-1034. https://doi.org/10.1016/S0140-6736(20)30628-0
9. Chen W, LanY, Yuan X, et al. Detectable 2019-nCoV viral RNA in blood is a strong indicator for the further clinical severity. Emerg Microbes Infect.2020;9:469–73. https://doi.org/10.1080/22221751.2020.1732837.
10. Huang C,Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497-506. https://doi.org/10.1016/S0140-6736(20)30183-5
11. Young, BE, Ong SWX, Kalimudiin S, et al. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA 323, 1488–1494 (2020). https://doi.org/10.1001/jama.2020.3204

12. Chang L, Yan Y, Wang L. Coronavirus disease 2019: corona viruses and blood safety. Transfus Med Rev. 2020; 34(2):75–80. https://doi.org/10.1016/j.tmrv.2020.02.003.
13. Hagman K, Hedenstierna M, Gille-Johnson P, et al. SARS-CoV-2 RNA in serum as predictor of severe outcome in COVID-19: a retrospective cohort study. Clin Infect Dis. 2020; 2020:1285. https://doi.org/10.1093/cid/ciaa1285
14. Zheng S, Fan J, Yu F, et al. Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January–March 2020: retrospective cohort study. BMJ. 2020; 369:m1443. https://doi.org/10.1136/bmj.m1443
15. Dodd RY, Stramer SL. COVID-19 and blood safety: help with a dilemma.Transfus Med Rev. 2020; 34(2):73–4. https://doi.org/10.1016/j.tmrv.2020.02.004
16. Chen X, Zhao B, Qu Y, et al. Detectable serum SARS-CoV-2 viral load (RNAemia) is closely correlated with drastically elevated interleukin 6 (IL-6) level in critically ill COVID-19 patients. Clin Infect Dis. 2020; ciaa449. https://doi.org/10.1093/cid/ciaa449
17. Wölfel R, Corman VM, Guggemos W, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. 2020; 581:465–9. https://doi.org/10.1038/s41586-020-2196-x
18. Xu H, Zhong L, Deng J, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020; 12(1):8. https://doi.org/10.1038/s41368-020-0074-x
19. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020; 323(11):1061-1069. https://doi.org/10.1001/jama.2020.1585.
20. Fan BE, Chong VCL, Chan SSW, et al. Hematologic parameters in patients with COVID-19 infection. Am J Hematol. 2020; 95(6):E131-E134. https:// doi.org/10.1002/ajh.25774.
21. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020; 8 (5):475-481. https://doi.org/10.1016/S2213-2600(20)30079-5.
22. Deng Y, Liu W, Liu K, et al. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 (COVID-19) in Wuhan, China: a retrospective study. Chin Med J (Engl). 2020; 133 (11):1261-1267. https://doi.org/10.1097/CM9.0000000000000824
23. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost JTH. 2020; 18(4):844–847. https://doi.org/10.1111/jth.14768
24. T. Liu, J. Zhang, Y. Yang, et al. The potential role of IL-6 in monitoring severe case of coronavirus disease 2019. Available: https://www.medrxiv.org/content/ 10.1101/2020.03.01.20029769v2 (accessed on December 29, 2020).

Details

Primary Language

English

Subjects

Health Care Administration

Journal Section

Research Article

Authors

Jyotsna Agarwal This is me
India

Vikramjeet Singh This is me
India

Jaya Garg This is me
India

Ritu Karoli2 This is me
India

Swasti Tiwari This is me
Palestine

Shareh Naqvi This is me
India

Anupam Das This is me
India

Manodeep Sen This is me
India

Publication Date

September 15, 2021

Submission Date

February 8, 2021

Acceptance Date

August 16, 2021

Published in Issue

Year 2021 Volume: 11 Number: 03

DOI

https://doi.org/10.5799/jmid.993839

IZ

https://izlik.org/JA93RG95AE

Cite

RIS / Bibtex

APA

Agarwal, J., Singh, V., Garg, J., Karoli2, R., Tiwari, S., Naqvi, S., Das, A., & Sen, M. (2021). RNAemia and Clinical Outcome in COVID-19 Patients. Journal of Microbiology and Infectious Diseases, 11(03), 116-123. https://doi.org/10.5799/jmid.993839

AMA

1.Agarwal J, Singh V, Garg J, et al. RNAemia and Clinical Outcome in COVID-19 Patients. J Microbil Infect Dis. 2021;11(03):116-123. doi:10.5799/jmid.993839

Chicago

Agarwal, Jyotsna, Vikramjeet Singh, Jaya Garg, et al. 2021. “RNAemia and Clinical Outcome in COVID-19 Patients”. Journal of Microbiology and Infectious Diseases 11 (03): 116-23. https://doi.org/10.5799/jmid.993839.

EndNote

Agarwal J, Singh V, Garg J, Karoli2 R, Tiwari S, Naqvi S, Das A, Sen M (September 1, 2021) RNAemia and Clinical Outcome in COVID-19 Patients. Journal of Microbiology and Infectious Diseases 11 03 116–123.

IEEE

[1]J. Agarwal et al., “RNAemia and Clinical Outcome in COVID-19 Patients”, J Microbil Infect Dis, vol. 11, no. 03, pp. 116–123, Sept. 2021, doi: 10.5799/jmid.993839.

ISNAD

Agarwal, Jyotsna - Singh, Vikramjeet - Garg, Jaya - Karoli2, Ritu - Tiwari, Swasti - Naqvi, Shareh - Das, Anupam - Sen, Manodeep. “RNAemia and Clinical Outcome in COVID-19 Patients”. Journal of Microbiology and Infectious Diseases 11/03 (September 1, 2021): 116-123. https://doi.org/10.5799/jmid.993839.

JAMA

1.Agarwal J, Singh V, Garg J, Karoli2 R, Tiwari S, Naqvi S, Das A, Sen M. RNAemia and Clinical Outcome in COVID-19 Patients. J Microbil Infect Dis. 2021;11:116–123.

MLA

Agarwal, Jyotsna, et al. “RNAemia and Clinical Outcome in COVID-19 Patients”. Journal of Microbiology and Infectious Diseases, vol. 11, no. 03, Sept. 2021, pp. 116-23, doi:10.5799/jmid.993839.

Vancouver

1.Jyotsna Agarwal, Vikramjeet Singh, Jaya Garg, Ritu Karoli2, Swasti Tiwari, Shareh Naqvi, Anupam Das, Manodeep Sen. RNAemia and Clinical Outcome in COVID-19 Patients. J Microbil Infect Dis. 2021 Sep. 1;11(03):116-23. doi:10.5799/jmid.993839