tetano
Editor, Senior Moderator
Emerg Microbes Infect
. 2020 Dec 1;1-26.
doi: 10.1080/22221751.2020.1858700. Online ahead of print.
High Anal Swab Viral Load Predisposes Adverse Clinical Outcomes in Severe COVID-19 Patients
Haibo Li[SUP] 1 2 [/SUP], Lili Ren[SUP] 3 4 [/SUP], Lulu Zhang[SUP] 3 [/SUP], Yeming Wang[SUP] 1 5 [/SUP], Li Guo[SUP] 3 4 [/SUP], Conghui Wang[SUP] 3 [/SUP], Yan Xiao[SUP] 3 4 [/SUP], Ying Wang[SUP] 3 [/SUP], Jian Rao[SUP] 3 [/SUP], Xinming Wang[SUP] 3 [/SUP], Ying Liu[SUP] 6 [/SUP], Chaolin Huang[SUP] 6 [/SUP], Xiaoying Gu[SUP] 7 [/SUP], Guohui Fan[SUP] 7 [/SUP], Hui Li[SUP] 1 2 [/SUP], Binghuai Lu[SUP] 1 2 [/SUP], Bin Cao[SUP] 1 2 5 8 [/SUP], Jianwei Wang[SUP] 3 4 [/SUP]
Affiliations
Abstract
The pandemic coronavirus disease 2019 (COVID-19) is characterized by systemic infection and multiorgan dysfunction. The association between the kinetics of viral load and clinical outcome in severe COVID-19 patients has not been well established. A retrospective study was performed on clinical specimens from 188 hospitalized severe COVID-19 patients involved in the LOTUS China trial. A total of 578 paired throat swab (TS) and anal swab (AS) samples were collected. Viral load was measured by using quantitative real-time PCR. Viral RNA was detected in 193 (33.4%) TS and 121 (20.9%) AS samples. A higher viral RNA load was found in TS than in AS, with means of 1.0?10[SUP]6[/SUP] and 2.3?10[SUP]5[/SUP] copies/ml, respectively. The median number of days from symptom onset to positive virus detection in AS samples was significantly lower in non-survivors than in survivors (14 days vs 19 days, P=0.007). The virus positive rate in AS (P=0.006) and the viral load in AS (P=0.006) were significantly higher in non-survivors than in survivors at week 2 post symptom onset. A high initial viral load in AS was associated with death (OR 1.368, 95% CI 1.076-1.741, P=0.011), admission to the intensive care unit (OR 1.237, 95% CI 1.001-1.528, P=0.049) and need for invasive mechanical ventilation (OR 1.340, 95% CI 1.076-1.669, P=0.009) in COVID-19 patients. A high viral load and early positive virus detection in AS predispose adverse outcomes of COVID-19. Viral replication in extrapulmonary sites should be monitored intensively during antiviral therapy.
Keywords: COVID-19; SARS-CoV-2; anal swabs; clinical outcome; viral load.
. 2020 Dec 1;1-26.
doi: 10.1080/22221751.2020.1858700. Online ahead of print.
High Anal Swab Viral Load Predisposes Adverse Clinical Outcomes in Severe COVID-19 Patients
Haibo Li[SUP] 1 2 [/SUP], Lili Ren[SUP] 3 4 [/SUP], Lulu Zhang[SUP] 3 [/SUP], Yeming Wang[SUP] 1 5 [/SUP], Li Guo[SUP] 3 4 [/SUP], Conghui Wang[SUP] 3 [/SUP], Yan Xiao[SUP] 3 4 [/SUP], Ying Wang[SUP] 3 [/SUP], Jian Rao[SUP] 3 [/SUP], Xinming Wang[SUP] 3 [/SUP], Ying Liu[SUP] 6 [/SUP], Chaolin Huang[SUP] 6 [/SUP], Xiaoying Gu[SUP] 7 [/SUP], Guohui Fan[SUP] 7 [/SUP], Hui Li[SUP] 1 2 [/SUP], Binghuai Lu[SUP] 1 2 [/SUP], Bin Cao[SUP] 1 2 5 8 [/SUP], Jianwei Wang[SUP] 3 4 [/SUP]
Affiliations
- PMID: 33259268
- DOI: 10.1080/22221751.2020.1858700
Abstract
The pandemic coronavirus disease 2019 (COVID-19) is characterized by systemic infection and multiorgan dysfunction. The association between the kinetics of viral load and clinical outcome in severe COVID-19 patients has not been well established. A retrospective study was performed on clinical specimens from 188 hospitalized severe COVID-19 patients involved in the LOTUS China trial. A total of 578 paired throat swab (TS) and anal swab (AS) samples were collected. Viral load was measured by using quantitative real-time PCR. Viral RNA was detected in 193 (33.4%) TS and 121 (20.9%) AS samples. A higher viral RNA load was found in TS than in AS, with means of 1.0?10[SUP]6[/SUP] and 2.3?10[SUP]5[/SUP] copies/ml, respectively. The median number of days from symptom onset to positive virus detection in AS samples was significantly lower in non-survivors than in survivors (14 days vs 19 days, P=0.007). The virus positive rate in AS (P=0.006) and the viral load in AS (P=0.006) were significantly higher in non-survivors than in survivors at week 2 post symptom onset. A high initial viral load in AS was associated with death (OR 1.368, 95% CI 1.076-1.741, P=0.011), admission to the intensive care unit (OR 1.237, 95% CI 1.001-1.528, P=0.049) and need for invasive mechanical ventilation (OR 1.340, 95% CI 1.076-1.669, P=0.009) in COVID-19 patients. A high viral load and early positive virus detection in AS predispose adverse outcomes of COVID-19. Viral replication in extrapulmonary sites should be monitored intensively during antiviral therapy.
Keywords: COVID-19; SARS-CoV-2; anal swabs; clinical outcome; viral load.