tetano
Editor, Senior Moderator
Proc Natl Acad Sci U S A
. 2021 Feb 23;118(8):e2017962118.
doi: 10.1073/pnas.2017962118.
Modeling SARS-CoV-2 viral kinetics and association with mortality in hospitalized patients from the French COVID cohort
Nad?ge N?ant[SUP] 1 [/SUP], Guillaume Lingas[SUP] 2 [/SUP], Quentin Le Hingrat[SUP] 2 3 [/SUP], Jade Ghosn[SUP] 2 4 [/SUP], Ilka Engelmann[SUP] 5 [/SUP], Quentin Lepiller[SUP] 6 [/SUP], Alexandre Gaymard[SUP] 7 8 [/SUP], Virginie Ferr?[SUP] 9 [/SUP], C?dric Hartard[SUP] 10 11 [/SUP], Jean-Christophe Plantier[SUP] 12 [/SUP], Vincent Thibault[SUP] 13 [/SUP], Julien Marlet[SUP] 14 15 [/SUP], Brigitte Montes[SUP] 16 [/SUP], Kevin Bouiller[SUP] 17 18 [/SUP], Fran?ois-Xavier Lescure[SUP] 4 [/SUP], Jean-Fran?ois Timsit[SUP] 2 19 [/SUP], Emmanuel Faure[SUP] 20 [/SUP], Julien Poissy[SUP] 21 [/SUP], Christian Chidiac[SUP] 22 [/SUP], Fran?ois Raffi[SUP] 23 24 [/SUP], Antoine Kimmoun[SUP] 25 [/SUP], Manuel Etienne[SUP] 26 [/SUP], Jean-Christophe Richard[SUP] 27 28 [/SUP], Pierre Tattevin[SUP] 29 [/SUP], Denis Garot[SUP] 30 [/SUP], Vincent Le Moing[SUP] 31 [/SUP], Delphine Bachelet[SUP] 32 [/SUP], Coralie Tardivon[SUP] 32 [/SUP], Xavier Duval[SUP] 2 33 [/SUP], Yazdan Yazdanpanah[SUP] 2 4 [/SUP], France Mentr?[SUP] 2 32 [/SUP], C?dric Laou?nan[SUP] 2 32 [/SUP], Benoit Visseaux[SUP] 2 3 [/SUP], J?r?mie Guedj[SUP] 2 [/SUP], French COVID Cohort Investigators and French Cohort Study groups
Affiliations
Abstract
The characterization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral kinetics in hospitalized patients and its association with mortality is unknown. We analyzed death and nasopharyngeal viral kinetics in 655 hospitalized patients from the prospective French COVID cohort. The model predicted a median peak viral load that coincided with symptom onset. Patients with age ≥65 y had a smaller loss rate of infected cells, leading to a delayed median time to viral clearance occurring 16 d after symptom onset as compared to 13 d in younger patients (P < 10[SUP]-4[/SUP]). In multivariate analysis, the risk factors associated with mortality were age ≥65 y, male gender, and presence of chronic pulmonary disease (hazard ratio
> 2.0). Using a joint model, viral dynamics after hospital admission was an independent predictor of mortality (HR = 1.31, P < 10[SUP]-3[/SUP]). Finally, we used our model to simulate the effects of effective pharmacological interventions on time to viral clearance and mortality. A treatment able to reduce viral production by 90% upon hospital admission would shorten the time to viral clearance by 2.0 and 2.9 d in patients of age <65 y and ≥65 y, respectively. Assuming that the association between viral dynamics and mortality would remain similar to that observed in our population, this could translate into a reduction of mortality from 19 to 14% in patients of age ≥65 y with risk factors. Our results show that viral dynamics is associated with mortality in hospitalized patients. Strategies aiming to reduce viral load could have an effect on mortality rate in this population.
Keywords: SARS-CoV-2; mortality; viral dynamics.
. 2021 Feb 23;118(8):e2017962118.
doi: 10.1073/pnas.2017962118.
Modeling SARS-CoV-2 viral kinetics and association with mortality in hospitalized patients from the French COVID cohort
Nad?ge N?ant[SUP] 1 [/SUP], Guillaume Lingas[SUP] 2 [/SUP], Quentin Le Hingrat[SUP] 2 3 [/SUP], Jade Ghosn[SUP] 2 4 [/SUP], Ilka Engelmann[SUP] 5 [/SUP], Quentin Lepiller[SUP] 6 [/SUP], Alexandre Gaymard[SUP] 7 8 [/SUP], Virginie Ferr?[SUP] 9 [/SUP], C?dric Hartard[SUP] 10 11 [/SUP], Jean-Christophe Plantier[SUP] 12 [/SUP], Vincent Thibault[SUP] 13 [/SUP], Julien Marlet[SUP] 14 15 [/SUP], Brigitte Montes[SUP] 16 [/SUP], Kevin Bouiller[SUP] 17 18 [/SUP], Fran?ois-Xavier Lescure[SUP] 4 [/SUP], Jean-Fran?ois Timsit[SUP] 2 19 [/SUP], Emmanuel Faure[SUP] 20 [/SUP], Julien Poissy[SUP] 21 [/SUP], Christian Chidiac[SUP] 22 [/SUP], Fran?ois Raffi[SUP] 23 24 [/SUP], Antoine Kimmoun[SUP] 25 [/SUP], Manuel Etienne[SUP] 26 [/SUP], Jean-Christophe Richard[SUP] 27 28 [/SUP], Pierre Tattevin[SUP] 29 [/SUP], Denis Garot[SUP] 30 [/SUP], Vincent Le Moing[SUP] 31 [/SUP], Delphine Bachelet[SUP] 32 [/SUP], Coralie Tardivon[SUP] 32 [/SUP], Xavier Duval[SUP] 2 33 [/SUP], Yazdan Yazdanpanah[SUP] 2 4 [/SUP], France Mentr?[SUP] 2 32 [/SUP], C?dric Laou?nan[SUP] 2 32 [/SUP], Benoit Visseaux[SUP] 2 3 [/SUP], J?r?mie Guedj[SUP] 2 [/SUP], French COVID Cohort Investigators and French Cohort Study groups
Affiliations
- PMID: 33536313
- DOI: 10.1073/pnas.2017962118
Abstract
The characterization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral kinetics in hospitalized patients and its association with mortality is unknown. We analyzed death and nasopharyngeal viral kinetics in 655 hospitalized patients from the prospective French COVID cohort. The model predicted a median peak viral load that coincided with symptom onset. Patients with age ≥65 y had a smaller loss rate of infected cells, leading to a delayed median time to viral clearance occurring 16 d after symptom onset as compared to 13 d in younger patients (P < 10[SUP]-4[/SUP]). In multivariate analysis, the risk factors associated with mortality were age ≥65 y, male gender, and presence of chronic pulmonary disease (hazard ratio
> 2.0). Using a joint model, viral dynamics after hospital admission was an independent predictor of mortality (HR = 1.31, P < 10[SUP]-3[/SUP]). Finally, we used our model to simulate the effects of effective pharmacological interventions on time to viral clearance and mortality. A treatment able to reduce viral production by 90% upon hospital admission would shorten the time to viral clearance by 2.0 and 2.9 d in patients of age <65 y and ≥65 y, respectively. Assuming that the association between viral dynamics and mortality would remain similar to that observed in our population, this could translate into a reduction of mortality from 19 to 14% in patients of age ≥65 y with risk factors. Our results show that viral dynamics is associated with mortality in hospitalized patients. Strategies aiming to reduce viral load could have an effect on mortality rate in this population.
Keywords: SARS-CoV-2; mortality; viral dynamics.