scholarly journals Disease Severity and Prognosis of SARS-CoV-2 Infection in Hospitalized Patients Is Not Associated With Viral Load in Nasopharyngeal Swab

2021 ◽  
Vol 8 ◽  
Author(s):  
Elisabetta Cocconcelli ◽  
Gioele Castelli ◽  
Francesco Onelia ◽  
Enrico Lavezzo ◽  
Chiara Giraudo ◽  
...  
Keyword(s):  
Viral Load ◽  
Medical Care ◽  
Disease Severity ◽  
High Intensity ◽  
Hospitalized Patients ◽  
Nasopharyngeal Swab ◽  
Asymptomatic Individuals ◽  
The Right ◽  
Asymptomatic Subjects ◽  
The Impact

Background: The impact of viral burden on severity and prognosis of patients hospitalized for Coronavirus Disease 2019 (COVID-19) is still a matter of debate due to controversial results. Herein, we sought to assess viral load in the nasopharyngeal swab and its association with severity score indexes and prognostic parameters.Methods: We included 127 symptomatic patients and 21 asymptomatic subjects with a diagnosis of SARS-CoV-2 infection obtained by reverse transcription polymerase chain reaction and presence of cycle threshold. According to the level of care needed during hospitalization, the population was categorized as high-intensity (HIMC, n = 76) or low intensity medical care setting (LIMC, n = 51).Results: Viral load did not differ among asymptomatic, LIMC, and HIMC SARS-CoV-2 positive patients [4.4 (2.9–5.3) vs. 4.8 (3.6–6.1) vs. 4.6 (3.9–5.7) log10 copies/ml, respectively; p = 0.31]. Similar results were observed when asymptomatic individuals were compared to hospitalized patients [4.4 (2.9–5.3) vs. 4.68 (3.8–5.9) log10 copies/ml; p = 0.13]. When the study population was divided in High (HVL, n = 64) and Low Viral Load (LVL, n = 63) group no differences were observed in disease severity at diagnosis. Furthermore, LVL and HVL groups did not differ with regard to duration of hospital stay, number of bacterial co-infections, need for high-intensity medical care and number of deaths. The viral load was not an independent risk factor for HIMC in an adjusted multivariate regression model (OR: 1.59; 95% CI: 0.46–5.55, p = 0.46).Conclusions: Viral load at diagnosis is similar in asymptomatic and hospitalized patients and is not associated with either worse outcomes during hospitalization. SARS CoV-2 viral load might not be the right tool to assist clinicians in risk-stratifying hospitalized patients.

scholarly journals Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Viral Load on Risk of Intubation and Mortality Among Hospitalized Patients With Coronavirus Disease 2019

2020 ◽  
Author(s):  
Reed Magleby ◽  
Lars F Westblade ◽  
Alex Trzebucki ◽  
Matthew S Simon ◽  
Mangala Rajan ◽  
...  
Keyword(s):  
New York ◽  
Viral Load ◽  
Severe Acute Respiratory Syndrome ◽  
Hospital Mortality ◽  
Smoking Status ◽  
High Viral Load ◽  
Hospitalized Patients ◽  
Nasopharyngeal Swab ◽  
Viral Loads ◽  
The Impact

Abstract Background Patients hospitalized with coronavirus disease 2019 (COVID-19) frequently require mechanical ventilation and have high mortality rates. However, the impact of viral burden on these outcomes is unknown. Methods We conducted a retrospective cohort study of patients hospitalized with COVID-19 from 30 March 2020 to 30 April 2020 at 2 hospitals in New York City. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load was assessed using cycle threshold (Ct) values from a reverse transcription-polymerase chain reaction assay applied to nasopharyngeal swab samples. We compared characteristics and outcomes of patients with high, medium, and low admission viral loads and assessed whether viral load was independently associated with intubation and in-hospital mortality. Results We evaluated 678 patients with COVID-19. Higher viral load was associated with increased age, comorbidities, smoking status, and recent chemotherapy. In-hospital mortality was 35.0% (Ct <25; n = 220), 17.6% (Ct 25–30; n = 216), and 6.2% (Ct >30; n = 242) with high, medium, and low viral loads, respectively (P < .001). The risk of intubation was also higher in patients with a high viral load (29.1%) compared with those with a medium (20.8%) or low viral load (14.9%; P < .001). High viral load was independently associated with mortality (adjusted odds ratio [aOR], 6.05; 95% confidence interval [CI], 2.92–12.52) and intubation (aOR, 2.73; 95% CI, 1.68–4.44). Conclusions Admission SARS-CoV-2 viral load among hospitalized patients with COVID-19 independently correlates with the risk of intubation and in-hospital mortality. Providing this information to clinicians could potentially be used to guide patient care.

THE IMPACT OF OUTPATIENT INHALED CORTICOSTEROID THERAPY ON DISEASE SEVERITY IN HOSPITALIZED PATIENTS WITH COMMUNITY ACQUIRED PNEUMONIA

CHEST Journal ◽  
2008 ◽  
Vol 134 (4) ◽  
pp. 16S
Author(s):  
Rosa Malo de Molina ◽  
Eric M. Mortensen ◽  
Patricia Castellanos-Matteus ◽  
Antonio Anzueto ◽  
Marcos I. Restrepo
Keyword(s):  
Disease Severity ◽  
Corticosteroid Therapy ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Inhaled Corticosteroid ◽  
The Impact

scholarly journals The Characterization of Disease Severity Associated IgG Subclasses Response in COVID-19 Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Huanle Luo ◽  
Tingting Jia ◽  
Jiamin Chen ◽  
Shike Zeng ◽  
Zengzhao Qiu ◽  
...  
Keyword(s):  
Viral Load ◽  
Disease Severity ◽  
Young Patients ◽  
Neutralizing Antibody ◽  
Igg Subclasses ◽  
Nasopharyngeal Swab ◽  
Obvious Effect ◽  
Old Patients ◽  
Biological Sex ◽  
Specific Igg

Increasing evidence suggests that dysregulated immune responses are associated with the clinical outcome of coronavirus disease 2019 (COVID-19). Nucleocapsid protein (NP)-, spike (S)-, receptor binding domain (RBD)- specific immunoglobulin (Ig) isotypes, IgG subclasses and neutralizing antibody (NAb) were analyzed in 123 serum from 63 hospitalized patients with severe, moderate, mild or asymptomatic COVID-19. Mild to modest correlations were found between disease severity and antigen specific IgG subclasses in serum, of which IgG1 and IgG3 were negatively associated with viral load in nasopharyngeal swab. Multiple cytokines were significantly related with antigen-specific Ig isotypes and IgG subclasses, and IL-1β was positively correlated with most antibodies. Furthermore, the old patients (≥ 60 years old) had higher levels of chemokines, increased NAb activities and SARS-CoV-2 specific IgG1, and IgG3 responses and compromised T cell responses compared to the young patients (≤ 18 years old), which are related with more severe cases. Higher IgG1 and IgG3 were found in COVID-19 patients with comorbidities while biological sex had no effect on IgG subclasses. Overall, we have identified diseases severity was related to higher antibodies, of which IgG subclasses had weakly negative correlation with viral load, and cytokines were significantly associated with antibody response. Further, advancing age and comorbidities had obvious effect on IgG1 and IgG3.

scholarly journals Genetic risk of dementia modifies the impact of obesity on limbic white matter and spatial navigation behavior in cognitively healthy adults

2019 ◽  
Author(s):  
Jilu P. Mole ◽  
Fabrizio Fasano ◽  
John Evans ◽  
Rebecca Sims ◽  
Derek A. Hamilton ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Genetic Risk ◽  
Magnetization Transfer ◽  
Spatial Navigation ◽  
Diffusion Imaging ◽  
Axon Density ◽  
Asymptomatic Individuals ◽  
The Right ◽  
The Impact

AbstractA family history (FH) of dementia, APOE-ε4 genotype, and obesity are major risk factors for developing Alzheimer’s disease but their combined effects on the brain and cognition remain elusive. We tested the hypothesis that these risk factors affect apparent white matter (WM) myelin and cognition including spatial navigation and processing speed in 166 asymptomatic individuals (38-71 years). Microstructure in temporal [fornix, parahippocampal cingulum, uncinate fasciculus], motor and whole-brain WM was assessed with myelin-sensitive indices from quantitative magnetization transfer [macromolecular proton fraction (MPF)] and axon density from diffusion imaging. Individuals with the highest genetic risk (FH+ and APOE-ε4) compared to those with FH+ alone showed obesity-related reductions in MPF and axon density in the right parahippocampal cingulum. No effects were present for those without FH. Furthermore, FH modulated obesity-related effects on spatial navigation behaviour. In summary, an individual’s genetic dementia risk influenced the impact of obesity on WM myelin and cognition.

Analysis of the toxicological situation in Moscow in the first three months of the COVID-19 pandemic

2021 ◽  
Vol 29 (5) ◽  
pp. 49-57
Author(s):  
Anastasiya Yurevna Simonova ◽  
Pavel Gennadevich Rozhkov ◽  
Mariya Vladimirovna Belova ◽  
Kapitolina Konstsntinovna Ilyashenko ◽  
Mikhail Mikhaylovich Potskhveriya ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Medical Care ◽  
Acute Poisoning ◽  
Hospitalized Patients ◽  
Toxic Effects ◽  
Alcohol Poisoning ◽  
Working Age ◽  
Coronavirus Infection ◽  
Restrictive Measures ◽  
The Impact

Introduction. On March 11, 2020, WHO announced the global COVID-19 pandemic. According to literature data, the spread of coronavirus infection COVID-19 affected the structure of acute chemical poisoning. The aim. Assessment of the impact of the COVID-19 pandemic and restrictive measures on the peculiarities of seeking advice and the structure of acute chemical poisoning in Moscow. Material and methods. The data of the registration forms “Card of recording of a consultation of a patient with acute poisoning of chemical etiology” in the period from March 30 to June 30, 2020 and 2019 were studied. The analysis indicators of a hospitalization of patients in the department of acute poisoning and somatopsychiatric disorders of N.V. Sklifosovsky, the Research Institute of Emergency Medicine. Results. It was found that in the analyzed period of 2020 compared to 2019, the proportion of injured people of working age decreased by 11.2%, while it increased at the age of 0-17 years by 3.2 times. An increase in the number of consultations for individuals by 2.1 times was noted. There was an increase in the number of complaints about poisoning with antibiotics, drugs from the T45 group (anticoagulants, vitamins, etc.), T37 (antiviral, anti-microbial, etc.) by 1.7-2 times. In March-June 2020, there was an increase in the number of complaints about the toxic effects of alcohol (T51), an increase in hospitalized patients with acute alcohol poisoning by 4 times, and with combined alcohol poisoning - by 2.7 times. The number of complaints about poisoning with detergents and disinfectants in the first three months of the pandemic increased by 2.7 times. Conclusion. The pandemic and the introduction of restrictive measures for COVID-19 have affected the toxicological situation in Moscow, which must be taken into account when determining the guidelines for organizational measures for the provision of medical care for acute chemical poisoning during the COVID-19 pandemic.

scholarly journals Baseline SARS-CoV-2 Viral Load is Associated With COVID-19 Disease Severity and Clinical Outcomes: Post-Hoc Analyses of a Phase 2/3 Trial

2021 ◽  
Author(s):  
Anita Boyapati ◽  
Matthew F Wipperman ◽  
Peter J Ehmann ◽  
Sara Hamon ◽  
David J Lederer ◽  
...  
Keyword(s):  
Viral Load ◽  
Clinical Outcomes ◽  
Disease Severity ◽  
Clinical Status ◽  
Supplemental Oxygen ◽  
Assisted Ventilation ◽  
Hospitalized Patients ◽  
Baseline Viral Load ◽  
Phase 2 ◽  
Post Hoc

Abstract Background Elucidating the relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and clinical outcomes is critical for understanding COVID-19. Methods SARS-CoV-2 levels were analyzed by quantitative real-time polymerase chain reaction (RT-qPCR) of nasopharyngeal or oropharyngeal swab specimens collected at baseline and clinical outcomes were recorded over 60 days from 1362 COVID-19 hospitalized patients enrolled in a multicenter, randomized, placebo-controlled phase 2/3 trial of sarilumab for COVID-19 (NCT04315298). Results In post-hoc analyses, higher baseline viral load, measured by both RT-qPCR cycle threshold (Ct) and log10 copies/mL, was associated with greater supplemental oxygenation requirements and disease severity at study entry. Higher baseline viral load was associated with higher mortality, lower likelihood of improvement in clinical status and supplemental oxygenation requirements, and lower rates of hospital discharge. Viral load was not impacted by sarilumab treatment over time versus placebo. Conclusions These data support viral load as an important determinant of clinical outcomes in hospitalized patients with COVID-19 requiring supplemental oxygen or assisted ventilation.

scholarly journals Assessment and Modeling of COVID-19 Outcomes in a Longitudinal Cohort of Hospitalized Adults

2021 ◽  
Author(s):  
Lacy M Simons ◽  
Ramon Lorenzo-Redondo ◽  
Meg Gibson ◽  
Sarah L Kinch ◽  
Jacob P Vandervaart ◽  
...  
Keyword(s):  
Viral Load ◽  
Disease Severity ◽  
Antibody Titer ◽  
Neutrophil Count ◽  
Clinical Management ◽  
Lymphocyte Count ◽  
Hospitalized Patients ◽  
Viral Genotype ◽  
Icu Admission ◽  
Over Time

Background: While several demographic and clinical correlates of Coronavirus Disease 2019 (COVID-19) outcome have been identified, they remain imprecise tools for clinical management of disease. Furthermore, there are limited data on how these factors are associated with virological and immunological parameters over time. Methods and Findings: Nasopharyngeal swabs and blood samples were longitudinally collected from a cohort of 58 hospitalized adults with COVID-19 in Chicago, Illinois between March 27 and June 9, 2020. Samples were assessed for SARS-CoV-2 viral load, viral genotype, viral diversity, and antibody titer. Demographic and clinical information, including patient blood tests and several composite measures of disease severity, were extracted from electronic health records. All parameters were assessed for association with three patient outcome groups: discharge without intensive care unit (ICU) admission (n = 23), discharge with ICU admission (n = 29), and COVID-19 related death (n = 6). Higher age, male sex, and higher body mass index (BMI) were significantly associated with ICU admission. At hospital admission, higher 4C Mortality scores and lactate dehydrogenase (LDH) levels were likewise associated with ICU admission. Longitudinal trends in Deterioration Index (DI) score, Modified Early Warning Score (MEWS), and serum neutrophil count were also associated with ICU admission, though only the retrospectively calculated median DI score was predictive of death. While viral load and genotype were not significantly associated with outcome in this study, viral load did correlate positively with C-reactive protein levels and negatively with D-dimer, lymphocyte count, and antibody titer. Intra-host viral genetic diversity resulted in changes in viral genotype in some participants over time, though intra-host evolution was not associated with outcome. A stepwise-generated multivariable model including BMI, lymphocyte count at admission, and neutrophil count at admission was sufficient to predict outcome with a 0.82 accuracy rate in this cohort. Conclusions: These studies suggest that COVID-19 disease severity and poor outcomes among hospitalized patients are likely driven by dysfunctional host responses to infection and underlying co-morbid conditions rather than SARS-CoV-2 viral loads. Several parameters, including 4C mortality score, LDH levels, and DI score, were ultimately predictive of participant outcome and warrant further exploration in larger cohort studies for use in clinical management and risk assessment. Finally, the prevalence of intra-host diversity and viral evolution in hospitalized patients suggests a mechanism for population-level change, further emphasizing the need for effective antivirals to suppress viral replication and to avoid the emergence of new variants.

scholarly journals Efficacy of Hydroxychloroquine and Tocilizumab in Patients With COVID-19: Single-Center Retrospective Chart Review (Preprint)

2020 ◽  
Author(s):  
Sohaib Roomi ◽  
Waqas Ullah ◽  
Faizan Ahmed ◽  
Soban Farooq ◽  
Usama Sadiq ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Hospital Mortality ◽  
Medical Care ◽  
Invasive Mechanical Ventilation ◽  
Hospitalized Patients ◽  
Odds Ratios ◽  
Significant Difference ◽  
The Impact

BACKGROUND During the initial phases of the COVID-19 pandemic, there was an unfounded fervor surrounding the use of hydroxychloroquine (HCQ) and tocilizumab (TCZ); however, evidence on their efficacy and safety have been controversial. OBJECTIVE The purpose of this study is to evaluate the overall clinical effectiveness of HCQ and TCZ in patients with COVID-19. We hypothesize that HCQ and TCZ use in these patients will be associated with a reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. METHODS A retrospective cohort study was performed to determine the impact of HCQ and TCZ use on hard clinical outcomes during hospitalization. A total of 176 hospitalized patients with a confirmed COVID-19 diagnosis was included. Patients were divided into two comparison groups: (1) HCQ (n=144) vs no-HCQ (n=32) and (2) TCZ (n=32) vs no-TCZ (n=144). The mean age, baseline comorbidities, and other medications used during hospitalization were uniformly distributed among all the groups. Independent <i>t</i> tests and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios with 95% CIs, respectively. RESULTS The unadjusted odds ratio for patients upgraded to a higher level of care (ie, intensive care unit) (OR 2.6, 95% CI 1.19-5.69; <i>P</i>=.003) and reductions in C-reactive protein (CRP) level on day 7 of hospitalization (21% vs 56%, OR 0.21, 95% CI 0.08-0.55; <i>P</i>=.002) were significantly higher in the TCZ group compared to the control group. There was no significant difference in the odds of in-hospital mortality, upgrade to intensive medical care, need for invasive mechanical ventilation, acute kidney failure necessitating dialysis, or discharge from the hospital after recovery in both the HCQ and TCZ groups compared to their respective control groups. Adjusted odds ratios controlled for baseline comorbidities and medications closely followed the unadjusted estimates. CONCLUSIONS In this cohort of patients with COVID-19, neither HCQ nor TCZ offered a significant reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. These results are similar to the recently published preliminary results of the HCQ arm of the Recovery trial, which showed no clinical benefit from the use of HCQ in hospitalized patients with COVID-19 (the TCZ arm is ongoing). Double-blinded randomized controlled trials are needed to further evaluate the impact of these drugs in larger patient samples so that data-driven guidelines can be deduced to combat this global pandemic.

scholarly journals SARS-CoV-2 Viral Load Is Correlated With the Disease Severity and Mortality in Patients With Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Maha Al-Mozaini ◽  
Abu Shadat M. Noman ◽  
Jawaher Alotaibi ◽  
Mohammed Rezaul Karim ◽  
A. S. M. Zahed ◽  
...  
Keyword(s):  
Viral Load ◽  
Cancer Patients ◽  
Disease Severity ◽  
High Viral Load ◽  
Attributable Mortality ◽  
Nasopharyngeal Swab ◽  
Viral Loads ◽  
Hematologic Cancer ◽  
Increased Risk ◽  
Anticancer Treatment

The correlation between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) viral load and risk of disease severity in cancer patients is poorly understood. Given the fact that cancer patients are at increased risk of severe coronavirus disease 2019 (COVID-19), analysis of viral load and disease outcome in COVID-19-infected cancer patients is needed. Here, we measured the SARS-CoV-2 viral load using qPCR cycle threshold (Ct) values collected from 120 noncancer and 64 cancer patients’ nasopharyngeal swab samples who are admitted to hospitals. Our results showed that the in-hospital mortality for high viral load cancer patients was 41.38%, 23.81% for medium viral load and 14.29% for low viral load patients (p &lt; −0.01). On the other hand, the mortality rate for noncancer patients was lower: 22.22% among patients with high viral load, 5.13% among patients with medium viral load, and 1.85% among patients with low viral load (p &lt; 0.05). In addition, patients with lung and hematologic cancer showed higher possibilities of severe events in proportion to high viral load. Higher attributable mortality and severity were directly proportional to high viral load particularly in patients who are receiving anticancer treatment. Importantly, we found that the incubation period and serial interval time is shorter in cancer patients compared with noncancer cases. Our report suggests that high SARS-CoV-2 viral loads may play a significant role in the overall mortality and severity of COVID-19-positive cancer patients, and this warrants further study to explore the disease pathogenesis and their use as prognostic tools.

scholarly journals COVID-19 in patients hospitalized and healthcare workers: what have changed after the first wave in a university hospital

2021 ◽  
Author(s):  
Luiz Vinicius Leao Moreira ◽  
Gabriela Barbosa ◽  
Luciano Kleber de Souza Luna ◽  
Alberto Fernando Oliveira Justo ◽  
Ana Paula Cunha Chaves ◽  
...  
Keyword(s):  
Viral Load ◽  
Healthcare Workers ◽  
Sao Paulo ◽  
Hospitalized Patients ◽  
University Hospital ◽  
São Paulo ◽  
The Mean ◽  
Wave Methods ◽  
The Impact ◽  
Pandemic Wave

Objective: To assess the COVID-19 frequency rates in hospitalized patients (HP) and healthcare workers (HCW), viral load inference, and the impact of vaccination and variants of concern (VOC) during the first pandemic wave. Methods: We evaluated the COVID-19 diagnostics at Hospital Sao Paulo, Brazil, from March 2020 to April 2021, in 10,202 samples (6,502 HP and 3,700 HCW) tested by RT-qPCR, inferring viral load by cycle threshold (Ct) values, and frequency rates. Results: SARS-CoV-2 was detected in 31.27% of individuals (32.23% HP and 29.80% HCW). The mean age of HP positives was 57.26 +/- 18.29 years (median = 59), with a mean Ct value of 25.55 +/- 6.07. Neither age nor Ct values in both groups have significantly differed during the first and second waves or even since the predominance of VOC P.1 on March 2021. Conclusions: The COVID-19 epidemic curves of HP and HCW accompanied the variations reported in Sao Paulo city, as well as the variation of hospitalization and occupancy of ICU beds. The VOC P.1 has no impact on the viral load, since its predominance in March 2021. The vaccination of HCW may have contributed to a decrease in the positivity rates, although more studies will provide a better understanding of the impact of immunization on the COVID-19 pandemic.

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