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Tedim AP, Almansa R, Domínguez‐Gil M, González‐Rivera M, Micheloud D, Ryan P, Méndez R, Blanca‐López N, Pérez‐García F, Bustamante E, Gómez JM, Doncel C, Trapiello W, Kelvin AA, Booth R, Ostadgavahi AT, Oneizat R, Puertas C, Barbé F, Ferrer R, Menéndez R, Bermejo‐Martin JF, Eiros JM, Kelvin DJ, Torres A. Comparison of real-time and droplet digital PCR to detect and quantify SARS-CoV-2 RNA in plasma. Eur J Clin Invest 2021; 51:e13501. [PMID: 33512013 PMCID: PMC7995030 DOI: 10.1111/eci.13501] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/13/2021] [Accepted: 01/25/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The presence of SARS-CoV-2 RNA in plasma has been linked to disease severity and mortality. We compared RT-qPCR to droplet digital PCR (ddPCR) to detect SARS-CoV-2 RNA in plasma from COVID-19 patients (mild, moderate, and critical disease). METHODS The presence/concentration of SARS-CoV-2 RNA in plasma was compared in three groups of COVID-19 patients (30 outpatients, 30 ward patients and 30 ICU patients) using both RT-qPCR and ddPCR. Plasma was obtained in the first 24h following admission, and RNA was extracted using eMAG. ddPCR was performed using Bio-Rad SARS-CoV-2 detection kit, and RT-qPCR was performed using GeneFinder™ COVID-19 Plus RealAmp Kit. Statistical analysis was performed using Statistical Package for the Social Science. RESULTS SARS-CoV-2 RNA was detected, using ddPCR and RT-qPCR, in 91% and 87% of ICU patients, 27% and 23% of ward patients and 3% and 3% of outpatients. The concordance of the results obtained by both methods was excellent (Cohen's kappa index = 0.953). RT-qPCR was able to detect 34/36 (94.4%) patients positive for viral RNA in plasma by ddPCR. Viral RNA load was higher in ICU patients compared with the other groups (P < .001), by both ddPCR and RT-qPCR. AUC analysis revealed Ct values (RT-qPCR) and viral RNA load values (ddPCR) can similarly differentiate between patients admitted to wards and to the ICU (AUC of 0.90 and 0.89, respectively). CONCLUSION Both methods yielded similar prevalence of RNAemia between groups, with ICU patients showing the highest (>85%). RT-qPCR was as useful as ddPCR to detect and quantify SARS-CoV-2 RNAemia in plasma.
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Affiliation(s)
- Ana P. Tedim
- Group for Biomedical Research in Sepsis (BioSepsis)Instituto de Investigación Biomédica de SalamancaSalamancaSpain
- Hospital Universitario Río HortegaValladolidSpain
| | - Raquel Almansa
- Group for Biomedical Research in Sepsis (BioSepsis)Instituto de Investigación Biomédica de SalamancaSalamancaSpain
- Hospital Universitario Río HortegaValladolidSpain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIAv. de Monforte de LemosMadridSpain
| | | | | | - Dariela Micheloud
- Emergency DepartmentHospital General Universitario Gregorio MarañónMadridSpain
| | - Pablo Ryan
- Hospital Universitario Infanta LeonorMadridSpain
| | - Raúl Méndez
- Pulmonology ServiceHospital Universitario y Politécnico de La FeAvinguda de Fernando Abril MartorellSpain
| | | | - Felipe Pérez‐García
- Servicio de Microbiología ClínicaHospital Universitario Príncipe de AsturiasMadridSpain
| | - Elena Bustamante
- Intensive Care UnitHospital Clínico Universitario de Valladolid. Av. Ramón y CajalValladolidSpain
| | - José Manuel Gómez
- Intensive Care Unit. Hospital General Universitario Gregorio MarañónMadridSpain
| | - Cristina Doncel
- Group for Biomedical Research in Sepsis (BioSepsis)Instituto de Investigación Biomédica de SalamancaSalamancaSpain
- Hospital Universitario Río HortegaValladolidSpain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIAv. de Monforte de LemosMadridSpain
| | - Wysali Trapiello
- Clinical Analysis Service. HospitalClínico Universitario de ValladolidAv. Ramón y CajalValladolidSpain
| | - Alyson A. Kelvin
- Department of Microbiology and ImmunologyFaculty of MedicineCanadian Center for Vaccinology CCfVDalhousie UniversityHalifaxNova ScotiaCanada
- Laboratory of ImmunityShantou University Medical CollegeJinping, ShantouChina
| | - Ryan Booth
- Department of Microbiology and ImmunologyFaculty of MedicineCanadian Center for Vaccinology CCfVDalhousie UniversityHalifaxNova ScotiaCanada
- Laboratory of ImmunityShantou University Medical CollegeJinping, ShantouChina
| | - Ali Toloue Ostadgavahi
- Department of Microbiology and ImmunologyFaculty of MedicineCanadian Center for Vaccinology CCfVDalhousie UniversityHalifaxNova ScotiaCanada
- Laboratory of ImmunityShantou University Medical CollegeJinping, ShantouChina
| | - Ruth Oneizat
- Microbiology ServiceHospital Universitario Rio HortegaValladolidSpain
| | - Carolina Puertas
- Department of Laboratory MedicineHospital General Universitario Gregorio MarañónMadridSpain
| | - Ferrán Barbé
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIAv. de Monforte de LemosMadridSpain
- Respiratory DepartmentInstitut Ricerca Biomedica de LleidaAv. Alcalde Rovira RoureLleidaSpain
| | - Ricard Ferrer
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIAv. de Monforte de LemosMadridSpain
- Intensive Care DepartmentSODIR Research GroupVall d’Hebron Hospital UniversitariVall d’Hebron Institut de RecercaBarcelonaSpain
| | - Rosario Menéndez
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIAv. de Monforte de LemosMadridSpain
- Pulmonology ServiceHospital Universitario y Politécnico de La FeAvinguda de Fernando Abril MartorellSpain
| | - Jesús F Bermejo‐Martin
- Group for Biomedical Research in Sepsis (BioSepsis)Instituto de Investigación Biomédica de SalamancaSalamancaSpain
- Hospital Universitario Río HortegaValladolidSpain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIAv. de Monforte de LemosMadridSpain
| | - José María Eiros
- Microbiology ServiceHospital Universitario Rio HortegaValladolidSpain
| | - David J Kelvin
- Department of Microbiology and ImmunologyFaculty of MedicineCanadian Center for Vaccinology CCfVDalhousie UniversityHalifaxNova ScotiaCanada
- Laboratory of ImmunityShantou University Medical CollegeJinping, ShantouChina
| | - Antoni Torres
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIAv. de Monforte de LemosMadridSpain
- Department of PulmonologyInstitut D investigacions August Pi I Sunyer (IDIBAPS)Hospital Clinic de BarcelonaUniversidad de BarcelonaBarcelonaSpain
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52
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Micheli V, Mancon A, Malara A, Mileto D, Villani PG, Rizzo A, Pagani C, Alquati O, Gismondo MR. What was behind the first recognition and characterization of autochthonous SARS-CoV-2 transmission in Italy: The impact on European scenario. Clin Case Rep 2021; 9:e04154. [PMID: 34178331 PMCID: PMC8209863 DOI: 10.1002/ccr3.4154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/08/2021] [Accepted: 03/14/2021] [Indexed: 11/08/2022] Open
Abstract
An Italian male with no link to China Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) epidemic presented at Emergency Room (ER) with severe respiratory impairment. The RT-PCR on 20 February 2020, nasopharyngeal swab revealed SARS-CoV-2 infection, confirmed with viral culture and sequencing. This was the first identified autochthonous SARS-CoV-2 transmission in Italy, that unveiled global pathogen diffusion. This clinical case highlights an underestimation of SARS-CoV-2 circulation, making initial containment measures unfit to face the real situation and delaying the management of potentially affected SARS-CoV-2 patients.
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Affiliation(s)
- Valeria Micheli
- Laboratory of Clinical Microbiology, Virology and BioemergenciesASST Fatebenefratelli Sacco – University of MilanMilanItaly
| | - Alessandro Mancon
- Laboratory of Clinical Microbiology, Virology and BioemergenciesASST Fatebenefratelli Sacco – University of MilanMilanItaly
| | - Annalisa Malara
- Anesthesia and ICU Department Maggiore HospitalASST LodiLodiItaly
| | - Davide Mileto
- Laboratory of Clinical Microbiology, Virology and BioemergenciesASST Fatebenefratelli Sacco – University of MilanMilanItaly
| | | | - Alberto Rizzo
- Laboratory of Clinical Microbiology, Virology and BioemergenciesASST Fatebenefratelli Sacco – University of MilanMilanItaly
| | - Cristina Pagani
- Laboratory of Clinical Microbiology, Virology and BioemergenciesASST Fatebenefratelli Sacco – University of MilanMilanItaly
| | - Omar Alquati
- Anesthesia and ICU Department Maggiore HospitalASST LodiLodiItaly
| | - Maria Rita Gismondo
- Laboratory of Clinical Microbiology, Virology and BioemergenciesASST Fatebenefratelli Sacco – University of MilanMilanItaly
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53
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SARS-CoV-2 RNA Quantification Using Droplet Digital RT-PCR. J Mol Diagn 2021; 23:907-919. [PMID: 34062285 PMCID: PMC8164350 DOI: 10.1016/j.jmoldx.2021.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/29/2021] [Accepted: 04/29/2021] [Indexed: 12/23/2022] Open
Abstract
Quantitative viral load assays have transformed our understanding of viral diseases. They hold similar potential to advance COVID-19 control and prevention, but SARS-CoV-2 viral load tests are not yet widely available. SARS-CoV-2 molecular diagnostic tests, which typically employ real-time RT-PCR, yield semiquantitative results only. Droplet digital RT-PCR (RT-ddPCR) offers an attractive platform for SARS-CoV-2 RNA quantification. Eight primer/probe sets originally developed for real-time RT-PCR–based SARS-CoV-2 diagnostic tests were evaluated for use in RT-ddPCR; three were identified as the most efficient, precise, and sensitive for RT-ddPCR–based SARS-CoV-2 RNA quantification. For example, the analytical efficiency for the E-Sarbeco primer/probe set was approximately 83%, whereas assay precision, measured as the coefficient of variation, was approximately 2% at 1000 input copies/reaction. Lower limits of quantification and detection for this primer/probe set were 18.6 and 4.4 input SARS-CoV-2 RNA copies/reaction, respectively. SARS-CoV-2 RNA viral loads in a convenience panel of 48 COVID-19–positive diagnostic specimens spanned a 6.2log10 range, confirming substantial viral load variation in vivo. RT-ddPCR–derived SARS-CoV-2 E gene copy numbers were further calibrated against cycle threshold values from a commercial real-time RT-PCR diagnostic platform. This log-linear relationship can be used to mathematically derive SARS-CoV-2 RNA copy numbers from cycle threshold values, allowing the wealth of available diagnostic test data to be harnessed to address foundational questions in SARS-CoV-2 biology.
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54
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Bakkour S, Saá P, Groves JA, Montalvo L, Di Germanio C, Best SM, Grebe E, Livezey K, Linnen JM, Strauss D, Kessler D, Bonn M, Green V, Williamson P, Kleinman S, Stramer SL, Stone M, Busch MP. Minipool testing for SARS-CoV-2 RNA in United States blood donors. Transfusion 2021; 61:2384-2391. [PMID: 34046906 DOI: 10.1111/trf.16511] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND SARS-CoV-2 RNA prevalence in blood donors from large geographic areas of high community transmission is limited. We tested residual donor plasma minipools (MPs) to determine SARS-CoV-2 RNAemia prevalence in six United States areas. STUDY DESIGN/METHODS Blood donations collected from 7 March 2020 to 25 September 2020 were tested for SARS-CoV-2 RNA (vRNA) in MP of 6 or 16 donations using the Grifols Procleix SARS-CoV-2 research-use only (RUO) transcription-mediated amplification (TMA) assay. Reactive results were confirmed using an alternate target region TMA assay. Reactive MPs were tested by TMA after serial dilution to estimate viral load. Testing for anti-SARS-CoV-2 antibodies and infectivity was performed. RESULTS A total of 17,995 MPs corresponding to approximately 258,000 donations were tested for vRNA. Three confirmed reactive MP16 were identified. The estimated prevalence of vRNA reactive donations was 1.16/100,000 (95% CI 0.40, 3.42). The vRNA-reactive samples were non-reactive for antibody, and the estimated viral loads of the (presumed single) positive donations within each MP ranged from <1000 to <4000 copies/ml. When tested, no infectivity was observed in inoculated permissive cell cultures. DISCUSSION Blood donation MP-nucleic acid testing (NAT) indicated that SARS-CoV-2 RNAemia is infrequent and, when detected, the vRNA was at low concentrations. Only one RNA-reactive MP could be tested for infectivity for operational reasons and was not infectious in cell culture. These findings support current recommendations from international and national regulatory agencies to not screen donors by NAT.
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Affiliation(s)
- Sonia Bakkour
- Vitalant Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paula Saá
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland, USA
| | - Jamel A Groves
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland, USA
| | | | | | - Sonja M Best
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
| | - Eduard Grebe
- Vitalant Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | | | | | - Donna Strauss
- New York Blood Center Enterprises, New York, New York, USA
| | - Debra Kessler
- New York Blood Center Enterprises, New York, New York, USA
| | - Mark Bonn
- Bloodworks Northwest, Seattle, Washington, USA
| | | | | | - Steve Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland, USA
| | - Mars Stone
- Vitalant Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
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55
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Buetti N, Patrier J, Le Hingrat Q, Loiodice A, Bouadma L, Visseaux B, Timsit JF. Risk Factors for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Detection in Blood of Critically Ill Patients. Clin Infect Dis 2021; 72:e690-e691. [PMID: 32875309 PMCID: PMC7499490 DOI: 10.1093/cid/ciaa1315] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Niccolò Buetti
- University of Paris, INSERM, IAME, Team DeSCID, Paris, France
| | - Juliette Patrier
- Medical and Infectious Diseases Intensive Care Unit (MI2), Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Quentin Le Hingrat
- Paris University, AP-HP, Hôpital Bichat-Claude-Bernard, IAME, INSERM, Laboratoire de Virologie, Paris, France
| | - Ambre Loiodice
- University of Paris, INSERM, IAME, Team DeSCID, Paris, France
| | - Lila Bouadma
- University of Paris, INSERM, IAME, Team DeSCID, Paris, France.,Medical and Infectious Diseases Intensive Care Unit (MI2), Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Benoit Visseaux
- Paris University, AP-HP, Hôpital Bichat-Claude-Bernard, IAME, INSERM, Laboratoire de Virologie, Paris, France
| | - Jean-François Timsit
- University of Paris, INSERM, IAME, Team DeSCID, Paris, France.,Medical and Infectious Diseases Intensive Care Unit (MI2), Bichat-Claude Bernard Hospital, AP-HP, Paris, France
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56
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Ramesh A, Potdar R, Bhandary R. Oral Fluids—A Diagnostic Tool for COVID-19: A Review. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2021. [DOI: 10.1055/s-0041-1726683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractGlobal outbreak of coronavirus disease 2019 (COVID-19) in December 2019 has affected millions of people around the world. This virus binds to angiotensin-converting enzyme-2 receptors present in the pharynx, nose, oral cavity, salivary glands, tongue, etc. Saliva has been shown to have viral loads of COVID-19 as it reported to be 2019-novel-coronavirus nucleic acid positive. This article is based on the association of oral fluids and their role in diagnosis of coronavirus infection.
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Affiliation(s)
- Amitha Ramesh
- A.B. Shetty Memorial Institute of Dental Sciences, NITTE (deemed to be) University, Mangalore, Karnataka, India
| | - Raksha Potdar
- A.B. Shetty Memorial Institute of Dental Sciences, NITTE (deemed to be) University, Mangalore, Karnataka, India
| | - Rahul Bhandary
- A.B. Shetty Memorial Institute of Dental Sciences, NITTE (deemed to be) University, Mangalore, Karnataka, India
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57
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Nunez Lopez YO, Casu A, Pratley RE. Investigation of Extracellular Vesicles From SARS-CoV-2 Infected Specimens: A Safety Perspective. Front Immunol 2021; 12:617042. [PMID: 33968019 PMCID: PMC8100059 DOI: 10.3389/fimmu.2021.617042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/25/2021] [Indexed: 12/19/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, is wreaking havoc around the world. Considering that extracellular vesicles (EVs) released from SARS-CoV-2 infected cells might play a role in a viremic phase contributing to disease progression and that standard methods for EV isolation have been reported to co-isolate viral particles, we would like to recommend the use of heightened laboratory safety measures during the isolation of EVs derived from SARS-CoV-2 infected tissue and blood from COVID-19 patients. Research needs to be conducted to better understand the role of EVs in SARS-CoV-2 infectivity, disease progression, and transmission. EV isolation procedures should include approaches for protection from SARS-CoV-2 contamination. We recommend the EV and virology scientific communities develop collaborative projects where relationships between endogenous EVs and potentially lethal enveloped viruses are addressed to better understand the risks and pathobiology involved.
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Affiliation(s)
- Yury O Nunez Lopez
- Translational Research Institute, AdventHealth, Orlando, FL, United States
| | - Anna Casu
- Translational Research Institute, AdventHealth, Orlando, FL, United States
| | - Richard E Pratley
- Translational Research Institute, AdventHealth, Orlando, FL, United States
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58
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Huang Z, Ning B, Yang HS, Youngquist BM, Niu A, Lyon CJ, Beddingfield BJ, Fears AC, Monk CH, Murrell AE, Bilton SJ, Linhuber JP, Norton EB, Dietrich ML, Yee J, Lai W, Scott JW, Yin XM, Rappaport J, Robinson JE, Saba NS, Roy CJ, Zwezdaryk KJ, Zhao Z, Hu TY. Sensitive tracking of circulating viral RNA through all stages of SARS-CoV-2 infection. J Clin Invest 2021; 131:146031. [PMID: 33561010 DOI: 10.1172/jci146031] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUNDCirculating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA may represent a more reliable indicator of infection than nasal RNA, but quantitative reverse transcription PCR (RT-qPCR) lacks diagnostic sensitivity for blood samples.METHODSA CRISPR-augmented RT-PCR assay that sensitively detects SARS-CoV-2 RNA was employed to analyze viral RNA kinetics in longitudinal plasma samples from nonhuman primates (NHPs) after virus exposure; to evaluate the utility of blood SARS-CoV-2 RNA detection for coronavirus disease 2019 (COVID-19) diagnosis in adults cases confirmed by nasal/nasopharyngeal swab RT-PCR results; and to identify suspected COVID-19 cases in pediatric and at-risk adult populations with negative nasal swab RT-qPCR results. All blood samples were analyzed by RT-qPCR to allow direct comparisons.RESULTSCRISPR-augmented RT-PCR consistently detected SARS-CoV-2 RNA in the plasma of experimentally infected NHPs from 1 to 28 days after infection, and these increases preceded and correlated with rectal swab viral RNA increases. In a patient cohort (n = 159), this blood-based assay demonstrated 91.2% diagnostic sensitivity and 99.2% diagnostic specificity versus a comparator RT-qPCR nasal/nasopharyngeal test, whereas RT-qPCR exhibited 44.1% diagnostic sensitivity and 100% specificity for the same blood samples. This CRISPR-augmented RT-PCR assay also accurately identified patients with COVID-19 using one or more negative nasal swab RT-qPCR results.CONCLUSIONResults of this study indicate that sensitive detection of SARS-CoV-2 RNA in blood by CRISPR-augmented RT-PCR permits accurate COVID-19 diagnosis, and can detect COVID-19 cases with transient or negative nasal swab RT-qPCR results, suggesting that this approach could improve COVID-19 diagnosis and the evaluation of SARS-CoV-2 infection clearance, and predict the severity of infection.TRIAL REGISTRATIONClinicalTrials.gov. NCT04358211.FUNDINGDepartment of Defense, National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Human Development, and the National Center for Research Resources.
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Affiliation(s)
- Zhen Huang
- Center for Cellular and Molecular Diagnostics, Tulane University School of Medicine, New Orleans, Louisiana, USA.,State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China.,Department of Biochemistry and Molecular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Bo Ning
- Center for Cellular and Molecular Diagnostics, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Biochemistry and Molecular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - He S Yang
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Brady M Youngquist
- Center for Cellular and Molecular Diagnostics, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Biochemistry and Molecular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Alex Niu
- Section of Hematology and Medical Oncology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Christopher J Lyon
- Center for Cellular and Molecular Diagnostics, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Biochemistry and Molecular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Brandon J Beddingfield
- Division of Microbiology, Tulane National Primate Research Center, Covington, Louisiana, USA
| | - Alyssa C Fears
- Division of Microbiology, Tulane National Primate Research Center, Covington, Louisiana, USA
| | | | | | | | | | | | | | - Jim Yee
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Weihua Lai
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China
| | - John W Scott
- Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Xiao-Ming Yin
- Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jay Rappaport
- Department of Microbiology and Immunology.,Tulane National Primate Research Center, Covington, Louisiana, USA
| | | | - Nakhle S Saba
- Section of Hematology and Medical Oncology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Chad J Roy
- Division of Microbiology, Tulane National Primate Research Center, Covington, Louisiana, USA.,Department of Microbiology and Immunology
| | | | - Zhen Zhao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Tony Y Hu
- Center for Cellular and Molecular Diagnostics, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Biochemistry and Molecular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
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59
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Venet F, Cour M, Rimmelé T, Viel S, Yonis H, Coudereau R, Amaz C, Abraham P, Monard C, Casalegno JS, Brengel-Pesce K, Lukaszewicz AC, Argaud L, Monneret G. Longitudinal assessment of IFN-I activity and immune profile in critically ill COVID-19 patients with acute respiratory distress syndrome. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:140. [PMID: 33845874 PMCID: PMC8040759 DOI: 10.1186/s13054-021-03558-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since the onset of the pandemic, only few studies focused on longitudinal immune monitoring in critically ill COVID-19 patients with acute respiratory distress syndrome (ARDS) whereas their hospital stay may last for several weeks. Consequently, the question of whether immune parameters may drive or associate with delayed unfavorable outcome in these critically ill patients remains unsolved. METHODS We present a dynamic description of immuno-inflammatory derangements in 64 critically ill COVID-19 patients including plasma IFNα2 levels and IFN-stimulated genes (ISG) score measurements. RESULTS ARDS patients presented with persistently decreased lymphocyte count and mHLA-DR expression and increased cytokine levels. Type-I IFN response was initially induced with elevation of IFNα2 levels and ISG score followed by a rapid decrease over time. Survivors and non-survivors presented with apparent common immune responses over the first 3 weeks after ICU admission mixing gradual return to normal values of cellular markers and progressive decrease of cytokines levels including IFNα2. Only plasma TNF-α presented with a slow increase over time and higher values in non-survivors compared with survivors. This paralleled with an extremely high occurrence of secondary infections in COVID-19 patients with ARDS. CONCLUSIONS Occurrence of ARDS in response to SARS-CoV2 infection appears to be strongly associated with the intensity of immune alterations upon ICU admission of COVID-19 patients. In these critically ill patients, immune profile presents with similarities with the delayed step of immunosuppression described in bacterial sepsis.
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Affiliation(s)
- Fabienne Venet
- Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France. .,Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France. .,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude, Bernard-Lyon 1, Lyon, France.
| | - Martin Cour
- Medical Intensive Care Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Thomas Rimmelé
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France.,Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Sebastien Viel
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude, Bernard-Lyon 1, Lyon, France.,Immunology Laboratory, Lyon-Sud University Hospital, Hospices Civils de Lyon, 69495, Pierre-Bénite, France
| | - Hodane Yonis
- Medical Intensive Care Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004, Lyon, France
| | - Remy Coudereau
- Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France
| | - Camille Amaz
- Centre d'Investigation Clinique de Lyon (CIC 1407 Inserm), Hospices Civils de Lyon, 69677, Lyon, France
| | - Paul Abraham
- Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Céline Monard
- Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Jean-Sebastien Casalegno
- Virology Laboratory, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69004, Lyon, France
| | - Karen Brengel-Pesce
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France
| | - Anne-Claire Lukaszewicz
- Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France.,Anesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Laurent Argaud
- Medical Intensive Care Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Guillaume Monneret
- Immunology Laboratory, Hôpital E. Herriot - Hospices Civils de Lyon, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.,Joint Research Unit HCL-bioMérieux, EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux), 69003, Lyon, France
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60
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Järhult JD, Hultström M, Bergqvist A, Frithiof R, Lipcsey M. The impact of viremia on organ failure, biomarkers and mortality in a Swedish cohort of critically ill COVID-19 patients. Sci Rep 2021; 11:7163. [PMID: 33785784 PMCID: PMC8010103 DOI: 10.1038/s41598-021-86500-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/16/2021] [Indexed: 12/15/2022] Open
Abstract
The 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. 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. In this cohort of 92 patients 59 (64%) were invasively ventilated. RNAemia was found in 31 patients (34%). Hypertension and corticosteroid treatment was more common in patients with RNAemia. 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. SARS-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 registration: ClinicalTrials NCT04316884.
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Affiliation(s)
- Josef D Järhult
- Department of Medical Sciences, Zoonosis Science Center, Uppsala University, Uppsala, Sweden
| | - Michael Hultström
- Department of Surgical Sciences, Anesthesia and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
- Integrative Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Anders Bergqvist
- Clinical Microbiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Clinical Microbiology and Hospital Infection Control, Uppsala University Hospital, Uppsala, Sweden
| | - Robert Frithiof
- Department of Surgical Sciences, Anesthesia and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- Department of Surgical Sciences, Anesthesia and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
- Hedenstierna Laboratory, CIRRUS, Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
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61
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Berastegui-Cabrera J, Salto-Alejandre S, Valerio M, Pérez-Palacios P, Revillas FADL, Abelenda-Alonso G, Oteo-Revuelta JA, Carretero-Ledesma M, Muñoz P, Pascual Á, Gozalo M, Rombauts A, Alba J, García-Díaz E, Rodríguez-Ferrero ML, Valiente A, Fariñas MC, Carratalà J, Santibáñez S, Camacho-Martínez P, Pachón J, Cisneros JM, Cordero E, Sánchez-Céspedes J. SARS-CoV-2 RNAemia is associated with severe chronic underlying diseases but not with nasopharyngeal viral load. J Infect 2021; 82:e38-e41. [PMID: 33248220 PMCID: PMC7688428 DOI: 10.1016/j.jinf.2020.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/22/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Judith Berastegui-Cabrera
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain
| | - Sonsoles Salto-Alejandre
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain
| | - Maricela Valerio
- Service of Clinical Microbiology and Infectious Diseases, Sanitary Research Institute, Gregorio Marañón University Hospital, Madrid, Spain
| | - Patricia Pérez-Palacios
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine. Virgen Macarena University Hospital, Seville, Spain
| | - Francisco Arnaiz-De Las Revillas
- Service of Infectious Diseases, Marqués de Valdecilla University Hospital, Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Gabriela Abelenda-Alonso
- Service of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Marta Carretero-Ledesma
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain
| | - Patricia Muñoz
- Service of Clinical Microbiology and Infectious Diseases, Sanitary Research Institute, Gregorio Marañón University Hospital, Madrid, Spain; CIBERES (CB06/06/0058), Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Álvaro Pascual
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain; Unit of Infectious Diseases, Microbiology, and Preventive Medicine. Virgen Macarena University Hospital, Seville, Spain
| | - Mónica Gozalo
- Service of Microbiology, Marqués de Valdecilla University Hospital, Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Alexander Rombauts
- Service of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Jorge Alba
- Department of Infectious Diseases, San Pedro-CIBIR University Hospital, Logroño, La Rioja, Spain
| | - Emilio García-Díaz
- Unit of Emergencies, Virgen del Rocío University Hospital, Seville, Spain
| | - María Luisa Rodríguez-Ferrero
- Service of Clinical Microbiology and Infectious Diseases, Sanitary Research Institute, Gregorio Marañón University Hospital, Madrid, Spain
| | - Adoración Valiente
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine. Virgen Macarena University Hospital, Seville, Spain
| | - María Carmen Fariñas
- Service of Infectious Diseases, Marqués de Valdecilla University Hospital, Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Jordi Carratalà
- Service of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Sonia Santibáñez
- Department of Infectious Diseases, San Pedro-CIBIR University Hospital, Logroño, La Rioja, Spain
| | - Pedro Camacho-Martínez
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - Jerónimo Pachón
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain; Department of Medicine, University of Seville, Sevilla, Spain
| | - José Miguel Cisneros
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain
| | - Elisa Cordero
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain; Department of Medicine, University of Seville, Sevilla, Spain.
| | - Javier Sánchez-Céspedes
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena /CSIC/University of Seville, Seville, Spain.
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62
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Li Y, Regan J, Fajnzylber J, Coxen K, Corry H, Wong C, Rosenthal A, Atyeo C, Fischinger S, Gillespie E, Chishti R, Baden L, Yu XG, Alter G, Kim A, Li JZ. Liver Fibrosis Index FIB-4 Is Associated With Mortality in COVID-19. Hepatol Commun 2021; 5:434-445. [PMID: 34553511 PMCID: PMC7753559 DOI: 10.1002/hep4.1650] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/27/2020] [Accepted: 11/01/2020] [Indexed: 12/11/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is associated with adverse outcomes, including need for invasive mechanical ventilation and death in people with risk factors. Liver enzyme elevation is commonly seen in this group, but its clinical significance remains elusive. In this study, we calculated the Fibrosis-4 (FIB-4) score for a cohort of hospitalized patients with COVID-19 and assessed its association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, inflammatory cytokine levels, and clinical outcome. A total of 202 hospitalized participants who tested positive for SARS-CoV-2 by nasopharyngeal sampling were included in this analysis. FIB-4 was calculated for each participant using the alanine aminotransferase, aspartate aminotransferase, age, and platelet count. We evaluated the association between FIB-4 and mortality using both multivariate logistic regression and Cox proportional hazards model. Correlations between FIB-4 and SARS-CoV-2 RNA and cytokine levels were evaluated using the Spearman test. Among the 202 participants, 22 died. The median FIB-4 in participants who survived and died were 1.91 and 3.98 (P < 0.001 by Mann-Whitney U test), respectively. Each one-unit increment in FIB-4 was associated with an increased odds of death (odds ratio, 1.79; 95% confidence interval, 1.36, 2.35; P < 0.001) after adjusting for baseline characteristics including sex, body mass index, hypertension, diabetes, and history of liver diseases. During hospitalization, FIB-4 peaked and then normalized in the survival group but failed to normalize in the death group. FIB-4 was positively correlated with the level of SARS-CoV-2 viral load and monocyte-associated cytokines, especially interleukin-6 and interferon gamma-induced protein 10. Conclusion: FIB-4 is associated with mortality in COVID-19, independent of underlying conditions including liver diseases. FIB-4 may be a simple and inexpensive approach to risk-stratify individuals with COVID-19.
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Affiliation(s)
- Yijia Li
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - James Regan
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Jesse Fajnzylber
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Kendyll Coxen
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Heather Corry
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Colline Wong
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Alexandra Rosenthal
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Caroline Atyeo
- Ragon Institute of MGHMIT and HarvardHarvard Medical SchoolCambridgeMAUSA
| | | | - Elizabeth Gillespie
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Rida Chishti
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Lindsey Baden
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Xu G Yu
- Ragon Institute of MGHMIT and HarvardHarvard Medical SchoolCambridgeMAUSA
| | - Galit Alter
- Ragon Institute of MGHMIT and HarvardHarvard Medical SchoolCambridgeMAUSA
- Division of Infectious DiseasesMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Arthur Kim
- Division of Infectious DiseasesMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Jonathan Z Li
- Division of Infectious DiseasesBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
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63
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Tang K, Wu L, Luo Y, Gong B. Quantitative assessment of SARS-CoV-2 RNAemia and outcome in patients with coronavirus disease 2019. J Med Virol 2021; 93:3165-3175. [PMID: 33590923 PMCID: PMC8014647 DOI: 10.1002/jmv.26876] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/28/2021] [Accepted: 02/13/2021] [Indexed: 01/08/2023]
Abstract
The disease spectrum of coronavirus disease 2019 (COVID‐19) varies from asymptomatic infection to critical illness and death. Identification of prognostic markers is vital for predicting progression and clinical practice. Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) RNA, known as RNAemia, has been detected in the blood. However, the potential clinical value of SARS‐CoV‐2 RNAemia remains unknown. We, therefore, conducted a meta‐analysis using a random‐effects model to estimate the pooled prevalence of SARS‐CoV‐2 RNAemia as well as summary strength of RNAemia in association with disease severity and unfavorable clinical outcomes. A total of 21 studies involving 2181 patients were included. SARS‐CoV‐2 RNAemia in COVID‐19 patients varied from 9.4% to 74.1%, with a pooled estimate of 34% (95% confidene interval [CI]: 26%–43%). Overall, SARS‐CoV‐2 RNAemia was associated with COVID‐19 severity with odds ratio (OR) of 5.43 (95% CI: 3.46–8.53). In addition, SARS‐CoV‐2 RNAemia was a significant risk factor for unfavorable clinical outcomes (OR = 6.54, 95% CI: 3.82–11.21). The summary OR was 4.28 (95% CI: 2.20–8.33) for intensive care unit (ICU) admission, 11.07 (95% CI: 5.60–21.88) for mortality. Furthermore, RNAemia was also a significant risk factor for invasive mechanical ventilation and multiple organ failure. SARS‐CoV‐2 RNAemia is associated with disease severity, ICU admission, death in COVID‐19, and may serve as a clinical predictor. More prospective trials in evaluating the potential of SARS‐CoV‐2 RNAemia as a prognostic indicator are necessary.
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Affiliation(s)
- Kefu Tang
- Prenatal Diagnosis Center, Department of Clinical Laboratory, Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
| | - Lei Wu
- Prenatal Diagnosis Center, Department of Clinical Laboratory, Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
| | - Ying Luo
- Prenatal Diagnosis Center, Department of Clinical Laboratory, Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
| | - Bo Gong
- Prenatal Diagnosis Center, Department of Clinical Laboratory, Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
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64
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Colagrossi L, Antonello M, Renica S, Merli M, Matarazzo E, Travi G, Vecchi M, Colombo J, Muscatello A, Grasselli G, Molteni SN, Scaravilli V, Cattaneo E, Fanti D, Vismara C, Bandera A, Gori A, Puoti M, Cento V, Alteri C, Perno CF. SARS-CoV-2 RNA in plasma samples of COVID-19 affected individuals: a cross-sectional proof-of-concept study. BMC Infect Dis 2021; 21:184. [PMID: 33596855 PMCID: PMC7887543 DOI: 10.1186/s12879-021-05886-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recent studies showed that plasma SARS-CoV-2 RNA seems to be associated with worse COVID-19 outcome. However, whether specific population can be at higher risk of viremia are to date unexplored. METHODS This cross-sectional proof-of-concept study included 41 SARS-CoV-2-positive adult individuals (six affected by haematological malignancies) hospitalized at two major hospital in Milan, for those demographic, clinical and laboratory data were available. SARS-CoV-2 load was quantified by ddPCR in paired plasma and respiratory samples. To assess significant differences between patients with and patients without viremia, Fisher exact test and Wilcoxon test were used for categorical and continuous variables, respectively. RESULTS Plasma SARS-CoV-2 RNA was found in 8 patients (19.5%), with a median (IQR) value of 694 (209-1023) copies/mL. Viremic patients were characterized by an higher mortality rate (50.0% vs 9.1%; p = 0.018) respect to patients without viremia. Viremic patients were more frequently affected by haematological malignancies (62.5% vs. 3.0%; p < 0.001), and had higher viral load in respiratory samples (9,404,000 [586,060-10,000,000] vs 1560 [312-25,160] copies/mL; p = 0.002). CONCLUSIONS Even if based on a small sample population, this proof-of-concept study poses the basis for an early identification of patients at higher risk of SARS-CoV-2 viremia, and therefore likely to develop severe COVID-19, and supports the need of a quantitative viral load determination in blood and respiratory samples of haematologic patients with COVID-19 in order to predict prognosis and consequently to help their further management.
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Affiliation(s)
- Luna Colagrossi
- Department of Laboratories, Unit of Diagnostic Microbiology and Immunology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Antonello
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
| | - Silvia Renica
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
| | - Marco Merli
- Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elisa Matarazzo
- Residency in Microbiology and Virology, Università degli Studi di Milano, Milan, Italy
| | - Giovanna Travi
- Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marta Vecchi
- Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Jacopo Colombo
- Department of Cardiotoracovascular Anesthesia and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonio Muscatello
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Giacomo Grasselli
- Department of Anaesthesia and Critical Care, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Silvia Nerini Molteni
- Chemical-clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Vittorio Scaravilli
- Department of Anaesthesia and Critical Care, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Emanuele Cattaneo
- Department of Anaesthesia and Critical Care, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Diana Fanti
- Chemical-clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Vismara
- Chemical-clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandra Bandera
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Andrea Gori
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Massimo Puoti
- Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Valeria Cento
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
| | - Claudia Alteri
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy.
| | - Carlo Federico Perno
- Department of Laboratories, Unit of Diagnostic Microbiology and Immunology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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65
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Cimolai N. The semantics of airborne microbial spread and environmental relevance: Back to Anderson and Cox. ENVIRONMENTAL RESEARCH 2021; 193:110448. [PMID: 33212132 DOI: 10.1016/j.envres.2020.110448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/29/2020] [Accepted: 11/08/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Nevio Cimolai
- Faculty of Medicine, The University of British Columbia, Children's and Women's Health Centre of British Columbia, 4480 Oak Street Vancouver, B.C. V6H3V4, Canada
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66
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Moore KM, Suthar MS. Comprehensive analysis of COVID-19 during pregnancy. Biochem Biophys Res Commun 2021; 538:180-186. [PMID: 33384142 PMCID: PMC7759124 DOI: 10.1016/j.bbrc.2020.12.064] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic resulting from the emergence of the coronavirus SARS-CoV-2 remains a major global health concern. Pregnant individuals are more likely to develop severe COVID-19 and a number of pregnancy complications have been observed in COVID-19 patients. To date, little is known about the impact of COVID-19 on pregnancy. In this review, we examine key aspects of pregnancy that may be impacted by COVID-19 and summarize the current literature on SARS-CoV-2 infection of the placenta and in utero vertical transmission. Furthermore, we highlight recent studies exploring the role of the maternal antibody response to SARS-CoV-2 during pregnancy and the passive transfer of maternal antibodies from mothers with COVID-19 to fetus.
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Affiliation(s)
- Kathryn M Moore
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, GA, 30322, USA; Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, 30329, USA; Yerkes National Primate Research Center, Atlanta, GA, 30329, USA
| | - Mehul S Suthar
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, GA, 30322, USA; Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, 30329, USA; Yerkes National Primate Research Center, Atlanta, GA, 30329, USA.
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67
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Szwebel TA, Veyer D, Robillard N, Eshagh D, Canoui E, Bruneau T, Contejean A, Azoulay C, Serrano T, Hueso T, Izquierdo L, Rozenberg F, Terrier B, Vignon M, Laurent-Puig P, Taly V, Bélec L, Kernéis S, Lacombe K, Péré H. Usefulness of Plasma SARS-CoV-2 RNA Quantification by Droplet-based Digital PCR to Monitor Treatment Against COVID-19 in a B-cell Lymphoma Patient. Stem Cell Rev Rep 2021; 17:296-299. [PMID: 33403488 PMCID: PMC7785125 DOI: 10.1007/s12015-020-10107-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 12/17/2022]
Abstract
We report the case of an HIV-1-infected patient, treated with anti-CD20 monoclonal antibody for a B-cell lymphoma previously treated by autologous stem cell transplant. He suffered from chronic COVID19 and we monitored by plasma SARS-CoV-2 RNA by highly sensitive droplet-based digital PCR technology (ddPCR). Under tocilizumab therapy and despite a first clinical improvement biologically associated with decreasing inflammatory markers, a slight increase of SARS-CoV-2 RNAaemia quantified by ddPCR was highlighted, confirming the absence of viral efficacy of this treatment and predicting the subsequent observed deterioration. As expected, his complete recovery, finally achieved after COVID-19 convalescent plasmatherapy, strictly paralleled plasma SARS-CoV-2 RNA clearance. With these results, we confirmed the interest of SARS-CoV-2 RNAaemia monitoring by ddPCR in COVID-19 patients, particularly during treatment, and firstly showed that this new and specific biomarker could be helpful to select eligible patient for anti-IL6 receptors therapy considering the variable levels of efficacy recently observed with such therapy.
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Affiliation(s)
- Tali-Anne Szwebel
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, AP-HP CUP, Paris, France
| | - David Veyer
- Service de Microbiologie (Unité de virologie), Assistance Publique Hôpitaux de Paris-Centre (AP-HP.Centre), Hôpital Européen Georges Pompidou, Paris, France.,Centre de Recherche des Cordeliers, Functional Genomics of Solid Tumors laboratory, Labex OncoImmunology, Sorbonne Université, Université de Paris, équipe labellisée Ligue Nationale contre le Cancer, Inserm, Paris, France
| | - Nicolas Robillard
- Service de Microbiologie (Unité de virologie), Assistance Publique Hôpitaux de Paris-Centre (AP-HP.Centre), Hôpital Européen Georges Pompidou, Paris, France
| | - Deborah Eshagh
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, AP-HP CUP, Paris, France
| | - Etienne Canoui
- Assistance Publique Hôpitaux de Paris-Centre (AP-HP.Centre), Equipe Mobile d'Infectiologie, Hôpital Cochin, Paris, France
| | - Thomas Bruneau
- Service de Microbiologie (Unité de virologie), Assistance Publique Hôpitaux de Paris-Centre (AP-HP.Centre), Hôpital Européen Georges Pompidou, Paris, France.,Personalized Medicine Pharmacogenomics, therapeutic optimization, eDIAG plateform, laboratory, équipe labellisée Ligue Nationale contre le Cancer, Labex OncoImmunology, Université de Paris, Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Paris, France
| | - Adrien Contejean
- Assistance Publique Hôpitaux de Paris-Centre (AP-HP.Centre), Equipe Mobile d'Infectiologie, Hôpital Cochin, Paris, France
| | - Celia Azoulay
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, AP-HP CUP, Paris, France
| | - Thomas Serrano
- Service de Microbiologie (Unité de virologie), Assistance Publique Hôpitaux de Paris-Centre (AP-HP.Centre), Hôpital Européen Georges Pompidou, Paris, France
| | - Thomas Hueso
- Gustave Roussy Institute, Hematology Department, Paris-Saclay University, Paris, France
| | - Laure Izquierdo
- Assistance Publique Hôpitaux de Paris-Centre (AP-HP.Centre), Service de Virologie, Hôpital Cochin, Paris, France
| | - Flore Rozenberg
- Assistance Publique Hôpitaux de Paris-Centre (AP-HP.Centre), Service de Virologie, Hôpital Cochin, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, AP-HP CUP, Paris, France.,Université de Paris PARCC, INSERM U970, Paris, France
| | - Marguerite Vignon
- Assistance Publique Hôpitaux de Paris-Centre (AP-HP.Centre), Hematology Department, Hôpital Cochin, Paris, France
| | - Pierre Laurent-Puig
- Personalized Medicine Pharmacogenomics, therapeutic optimization, eDIAG plateform, laboratory, équipe labellisée Ligue Nationale contre le Cancer, Labex OncoImmunology, Université de Paris, Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Paris, France.,Assistance Publique Hôpitaux de Paris-Centre (AP-HP.Centre), Service de Biochimie, Hôpital Européen Georges Pompidou, Paris, France
| | - Valérie Taly
- Personalized Medicine Pharmacogenomics, therapeutic optimization, eDIAG plateform, laboratory, équipe labellisée Ligue Nationale contre le Cancer, Labex OncoImmunology, Université de Paris, Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Paris, France
| | - Laurent Bélec
- Service de Microbiologie (Unité de virologie), Assistance Publique Hôpitaux de Paris-Centre (AP-HP.Centre), Hôpital Européen Georges Pompidou, Paris, France.,Université de Paris PARCC, INSERM U970, Paris, France
| | - Solen Kernéis
- Assistance Publique Hôpitaux de Paris-Centre (AP-HP.Centre), Equipe Mobile d'Infectiologie, Hôpital Cochin, Paris, France.,Unité d'Epidémiologie et Modélisation de la Résistance aux Antimicrobiens, Institut Pasteur , Paris, France
| | - Karine Lacombe
- Inserm IPLESP , Sorbonne University , Paris, France.,Assistance Publique Hôpitaux de Paris, Service d'Infectiologie, Hôpital St Antoine, Paris, France
| | - Hélène Péré
- Service de Microbiologie (Unité de virologie), Assistance Publique Hôpitaux de Paris-Centre (AP-HP.Centre), Hôpital Européen Georges Pompidou, Paris, France.,Centre de Recherche des Cordeliers, Functional Genomics of Solid Tumors laboratory, Labex OncoImmunology, Sorbonne Université, Université de Paris, équipe labellisée Ligue Nationale contre le Cancer, Inserm, Paris, France
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68
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Smith N, Goncalves P, Charbit B, Grzelak L, Beretta M, Planchais C, Bruel T, Rouilly V, Bondet V, Hadjadj J, Yatim N, Pere H, Merkling SH, Ghozlane A, Kernéis S, Rieux-Laucat F, Terrier B, Schwartz O, Mouquet H, Duffy D, Di Santo JP. Distinct systemic and mucosal immune responses during acute SARS-CoV-2 infection. Nat Immunol 2021; 22:1428-1439. [PMID: 34471264 PMCID: PMC8553615 DOI: 10.1038/s41590-021-01028-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/12/2021] [Indexed: 01/20/2023]
Abstract
Coordinated local mucosal and systemic immune responses following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection either protect against coronavirus disease 2019 (COVID-19) pathologies or fail, leading to severe clinical outcomes. To understand this process, we performed an integrated analysis of SARS-CoV-2 spike-specific antibodies, cytokines, viral load and bacterial communities in paired nasopharyngeal swabs and plasma samples from a cohort of clinically distinct patients with COVID-19 during acute infection. Plasma viral load was associated with systemic inflammatory cytokines that were elevated in severe COVID-19, and also with spike-specific neutralizing antibodies. By contrast, nasopharyngeal viral load correlated with SARS-CoV-2 humoral responses but inversely with interferon responses, the latter associating with protective microbial communities. Potential pathogenic microorganisms, often implicated in secondary respiratory infections, were associated with mucosal inflammation and elevated in severe COVID-19. Our results demonstrate distinct tissue compartmentalization of SARS-CoV-2 immune responses and highlight a role for the nasopharyngeal microbiome in regulating local and systemic immunity that determines COVID-19 clinical outcomes.
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Affiliation(s)
- Nikaïa Smith
- grid.428999.70000 0001 2353 6535Translational Immunology Lab, Institut Pasteur, Paris, France
| | - Pedro Goncalves
- grid.428999.70000 0001 2353 6535Innate Immunity Unit, Institut Pasteur, INSERM U1223, Paris, France
| | - Bruno Charbit
- grid.428999.70000 0001 2353 6535Cytometry and Biomarkers UTechS, Institut Pasteur, Paris, France
| | - Ludivine Grzelak
- grid.428999.70000 0001 2353 6535Virus and Immunity Unit, Institut Pasteur, Paris, France ,grid.508487.60000 0004 7885 7602Sorbonne Paris Cité, Université de Paris, Paris, France
| | - Maxime Beretta
- grid.428999.70000 0001 2353 6535Humoral Immunology Laboratory, Institut Pasteur, INSERM U1222, Paris, France
| | - Cyril Planchais
- grid.428999.70000 0001 2353 6535Humoral Immunology Laboratory, Institut Pasteur, INSERM U1222, Paris, France
| | - Timothée Bruel
- grid.428999.70000 0001 2353 6535Virus and Immunity Unit, Institut Pasteur, Paris, France
| | | | - Vincent Bondet
- grid.428999.70000 0001 2353 6535Translational Immunology Lab, Institut Pasteur, Paris, France
| | - Jérôme Hadjadj
- grid.508487.60000 0004 7885 7602Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Université de Paris, Paris, France ,grid.508487.60000 0004 7885 7602Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, Université de Paris, Paris, France
| | - Nader Yatim
- grid.428999.70000 0001 2353 6535Translational Immunology Lab, Institut Pasteur, Paris, France ,grid.508487.60000 0004 7885 7602Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Université de Paris, Paris, France
| | - Helene Pere
- grid.417925.cUnité de Génomique Fonctionnelle des Tumeurs Solides, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Sarah H. Merkling
- grid.428999.70000 0001 2353 6535Insect-Virus Interactions Unit, Institut Pasteur, CNRS UMR2000, Paris, France
| | - Amine Ghozlane
- grid.428999.70000 0001 2353 6535Hub de Bioinformatique et Biostatistique, Institut Pasteur, Paris, France
| | - Solen Kernéis
- grid.411784.f0000 0001 0274 3893Equipe Mobile d’Infectiologie, Hôpital Cochin, AP-HP, APHP-CUP, Paris, France ,Université de Paris, INSERM, IAME, Paris, France ,grid.428999.70000 0001 2353 6535Epidemiology and Antimicrobial Resistance Modeling Laboratory, Institut Pasteur, Paris, France
| | - Frederic Rieux-Laucat
- grid.508487.60000 0004 7885 7602Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, Université de Paris, Paris, France
| | - Benjamin Terrier
- grid.508487.60000 0004 7885 7602Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Université de Paris, Paris, France
| | - Olivier Schwartz
- grid.428999.70000 0001 2353 6535Virus and Immunity Unit, Institut Pasteur, Paris, France
| | - Hugo Mouquet
- grid.428999.70000 0001 2353 6535Humoral Immunology Laboratory, Institut Pasteur, INSERM U1222, Paris, France
| | - Darragh Duffy
- grid.428999.70000 0001 2353 6535Translational Immunology Lab, Institut Pasteur, Paris, France
| | - James P. Di Santo
- grid.428999.70000 0001 2353 6535Innate Immunity Unit, Institut Pasteur, INSERM U1223, Paris, France
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69
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Abstract
PURPOSE OF REVIEW In response to the HIV-AIDS pandemic, great strides have been made in developing molecular methods that accurately quantify nucleic acid products of HIV-1 at different stages of viral replication and to assess HIV-1 sequence diversity and its effect on susceptibility to small molecule inhibitors and neutralizing antibodies. Here, we review how knowledge gained from these approaches, including viral RNA quantification and sequence analyses, have been rapidly applied to study SARS-CoV-2 and the COVID-19 pandemic. RECENT FINDINGS Recent studies have shown detection of SARS-CoV-2 RNA in blood of infected individuals by reverse transcriptase PCR (RT-PCR); and, as in HIV-1 infection, there is growing evidence that the level of viral RNA in plasma may be related to COVID disease severity. Unlike HIV-1, SARS-CoV-2 sequences are highly conserved limiting SARS-CoV-2 sequencing applications to investigating interpatient genetic diversity for phylogenetic analysis. Sensitive sequencing technologies, originally developed for HIV-1, will be needed to investigate intrapatient SARS-CoV-2 genetic variation in response to antiviral therapeutics and vaccines. SUMMARY Methods used for HIV-1 have been rapidly applied to SARS-CoV-2/COVID-19 to understand pathogenesis and prognosis. Further application of such methods should improve precision of therapy and outcome.
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Affiliation(s)
- Kevin D McCormick
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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70
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Ram-Mohan N, Kim D, Zudock EJ, Hashemi MM, Tjandra KC, Rogers AJ, Blish CA, Nadeau KC, Newberry JA, Quinn JV, O’Hara R, Ashley E, Nguyen H, Jiang L, Hung P, Blomkalns AL, Yang S. SARS-CoV-2 RNAaemia predicts clinical deterioration and extrapulmonary complications from COVID-19. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.12.19.20248561. [PMID: 33398290 PMCID: PMC7781329 DOI: 10.1101/2020.12.19.20248561] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The determinants of COVID-19 disease severity and extrapulmonary complications (EPCs) are poorly understood. We characterise the relationships between SARS-CoV-2 RNAaemia and disease severity, clinical deterioration, and specific EPCs. Methods We used quantitative (qPCR) and digital (dPCR) PCR to quantify SARS-CoV-2 RNA from nasopharyngeal swabs and plasma in 191 patients presenting to the Emergency Department (ED) with COVID-19. We recorded patient symptoms, laboratory markers, and clinical outcomes, with a focus on oxygen requirements over time. We collected longitudinal plasma samples from a subset of patients. We characterised the role of RNAaemia in predicting clinical severity and EPCs using elastic net regression. Findings 23·0% (44/191) of SARS-CoV-2 positive patients had viral RNA detected in plasma by dPCR, compared to 1·4% (2/147) by qPCR. Most patients with serial measurements had undetectable RNAaemia 10 days after onset of symptoms, but took 16 days to reach maximum severity, and 33 days for symptoms to resolve. Initially RNAaemic patients were more likely to manifest severe disease (OR 6·72 [95% CI, 2·45 - 19·79]), worsening of disease severity (OR 2·43 [95% CI, 1·07 - 5·38]), and EPCs (OR 2·81 [95% CI, 1·26 - 6·36]). RNA load correlated with maximum severity (r = 0·47 [95% CI, 0·20 - 0·67]). Interpretation dPCR is more sensitive than qPCR for the detection of SARS-CoV-2 RNAaemia, which is a robust predictor of eventual COVID-19 severity and oxygen requirements, as well as EPCs. Since many COVID-19 therapies are initiated on the basis of oxygen requirements, RNAaemia on presentation might serve to direct early initiation of appropriate therapies for the patients most likely to deteriorate.
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Affiliation(s)
- Nikhil Ram-Mohan
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto CA 94305
| | - David Kim
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto CA 94305
| | - Elizabeth J Zudock
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto CA 94305
| | - Marjan M Hashemi
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto CA 94305
| | - Kristel C Tjandra
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto CA 94305
| | - Angela J Rogers
- Department of Medicine - Pulmonary, Allergy & Critical Care Medicine, Stanford University School of Medicine, Palo Alto CA 94305
| | - Catherine A Blish
- Department of Medicine/Infectious Diseases, Stanford University School of Medicine, Palo Alto CA 94305
| | - Kari C. Nadeau
- Department of Medicine - Pulmonary, Allergy & Critical Care Medicine, Stanford University School of Medicine, Palo Alto CA 94305
| | - Jennifer A Newberry
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto CA 94305
| | - James V Quinn
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto CA 94305
| | - Ruth O’Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto CA 94305
| | - Euan Ashley
- Department of Medicine – Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto CA 94305
| | - Hien Nguyen
- COMBiNATi Inc., 2450 Embarcadero Way, Palo Alto CA 94303
| | - Lingxia Jiang
- COMBiNATi Inc., 2450 Embarcadero Way, Palo Alto CA 94303
| | - Paul Hung
- COMBiNATi Inc., 2450 Embarcadero Way, Palo Alto CA 94303
| | | | - Andra L Blomkalns
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto CA 94305
| | - Samuel Yang
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto CA 94305
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71
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Bury L, Camilloni B, Castronari R, Piselli E, Malvestiti M, Borghi M, KuchiBotla H, Falcinelli E, Petito E, Amato F, Paliani U, Vaudo G, Cerotto V, Gori F, Becattini C, De Robertis E, Lazzarini T, Castaldo G, Mencacci A, Gresele P. Search for SARS-CoV-2 RNA in platelets from COVID-19 patients. Platelets 2020; 32:284-287. [PMID: 33349108 DOI: 10.1080/09537104.2020.1859104] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The frequent finding of thrombocytopenia in patients with severe SARS-CoV-2 infection (COVID-19) and previous evidence that several viruses enter platelets suggest that SARS-CoV-2 might be internalized by platelets of COVID-19. Aim of our study was to assess the presence of SARS-CoV-2 RNA in platelets from hospitalized patients with aconfirmed diagnosis of COVID-19. RNA was extracted from platelets, leukocytes and serum from 24 COVID-19 patients and 3 healthy controls, real-time PCR and ddPCR for viral genes were carried out. SARS-CoV-2 RNA was not detected in any of the samples analyzed nor in healthy controls, by either RT-PCR or ddPCR, while RNA samples from nasopharyngeal swabs of COVID-19 patients were correctly identified. Viral RNA was not detected independently of viral load, of positive nasopharyngeal swabs, or viremia, the last detected in only one patient (4.1%). SARS-CoV-2 entry in platelets is not acommon phenomenon in COVID-19 patients, differently from other viral infections.
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Affiliation(s)
- Loredana Bury
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Barbara Camilloni
- Department of Medicine and Surgery, Microbiology Unit, University of Perugia, Perugia, Italy
| | - Roberto Castronari
- Department of Medicine and Surgery, Microbiology Unit, University of Perugia, Perugia, Italy
| | - Elisa Piselli
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Marco Malvestiti
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Mariachiara Borghi
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Haripriya KuchiBotla
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Emanuela Falcinelli
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Eleonora Petito
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Felice Amato
- Università Di Napoli Federico II, Naples, Italy.,CEINGE-Biotecnologie Avanzate, Naples, Italy
| | - Ugo Paliani
- Division of Internal Medicine, ASL 1 Umbria, Città Di Castello, Italy
| | - Gaetano Vaudo
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Vittorio Cerotto
- Section of Anesthesia, Intensive Care and Pain Medicine, Department of Emergency and Urgency, Città Di Castello Hospital, Città Di Castello, Italy
| | - Fabio Gori
- Section of Anesthesia, Intensive Care, and Pain Medicine, Azienda Ospedaliera-Universitaria Santa Maria Della Misericordia, Perugia, Italy
| | - Cecilia Becattini
- Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Perugia, Italy
| | - Edoardo De Robertis
- Department of Medicine and Surgery, Division of Anaesthesia, Analgesia, and Intensive Care, University of Perugia, Perugia, Italy
| | - Teseo Lazzarini
- Section of Anesthesia and Intensive Care, Presidio Alto Chiascio, USL Umbria 1, Gubbio, Italy
| | | | - Antonella Mencacci
- Department of Medicine and Surgery, Microbiology Unit, University of Perugia, Perugia, Italy
| | - Paolo Gresele
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
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72
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Bermejo-Martin JF, González-Rivera M, Almansa R, Micheloud D, Tedim AP, Domínguez-Gil M, Resino S, Martín-Fernández M, Ryan Murua P, Pérez-García F, Tamayo L, Lopez-Izquierdo R, Bustamante E, Aldecoa C, Gómez JM, Rico-Feijoo J, Orduña A, Méndez R, Fernández Natal I, Megías G, González-Estecha M, Carriedo D, Doncel C, Jorge N, Ortega A, de la Fuente A, Del Campo F, Fernández-Ratero JA, Trapiello W, González-Jiménez P, Ruiz G, Kelvin AA, Ostadgavahi AT, Oneizat R, Ruiz LM, Miguéns I, Gargallo E, Muñoz I, Pelegrin S, Martín S, García Olivares P, Cedeño JA, Ruiz Albi T, Puertas C, Berezo JÁ, Renedo G, Herrán R, Bustamante-Munguira J, Enríquez P, Cicuendez R, Blanco J, Abadia J, Gómez Barquero J, Mamolar N, Blanca-López N, Valdivia LJ, Fernández Caso B, Mantecón MÁ, Motos A, Fernandez-Barat L, Ferrer R, Barbé F, Torres A, Menéndez R, Eiros JM, Kelvin DJ. Viral RNA load in plasma is associated with critical illness and a dysregulated host response in COVID-19. Crit Care 2020; 24:691. [PMID: 33317616 PMCID: PMC7734467 DOI: 10.1186/s13054-020-03398-0] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/18/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND COVID-19 can course with respiratory and extrapulmonary disease. SARS-CoV-2 RNA is detected in respiratory samples but also in blood, stool and urine. Severe COVID-19 is characterized by a dysregulated host response to this virus. We studied whether viral RNAemia or viral RNA load in plasma is associated with severe COVID-19 and also to this dysregulated response. METHODS A total of 250 patients with COVID-19 were recruited (50 outpatients, 100 hospitalized ward patients and 100 critically ill). Viral RNA detection and quantification in plasma was performed using droplet digital PCR, targeting the N1 and N2 regions of the SARS-CoV-2 nucleoprotein gene. The association between SARS-CoV-2 RNAemia and viral RNA load in plasma with severity was evaluated by multivariate logistic regression. Correlations between viral RNA load and biomarkers evidencing dysregulation of host response were evaluated by calculating the Spearman correlation coefficients. RESULTS The frequency of viral RNAemia was higher in the critically ill patients (78%) compared to ward patients (27%) and outpatients (2%) (p < 0.001). Critical patients had higher viral RNA loads in plasma than non-critically ill patients, with non-survivors showing the highest values. When outpatients and ward patients were compared, viral RNAemia did not show significant associations in the multivariate analysis. In contrast, when ward patients were compared with ICU patients, both viral RNAemia and viral RNA load in plasma were associated with critical illness (OR [CI 95%], p): RNAemia (3.92 [1.183-12.968], 0.025), viral RNA load (N1) (1.962 [1.244-3.096], 0.004); viral RNA load (N2) (2.229 [1.382-3.595], 0.001). Viral RNA load in plasma correlated with higher levels of chemokines (CXCL10, CCL2), biomarkers indicative of a systemic inflammatory response (IL-6, CRP, ferritin), activation of NK cells (IL-15), endothelial dysfunction (VCAM-1, angiopoietin-2, ICAM-1), coagulation activation (D-Dimer and INR), tissue damage (LDH, GPT), neutrophil response (neutrophils counts, myeloperoxidase, GM-CSF) and immunodepression (PD-L1, IL-10, lymphopenia and monocytopenia). CONCLUSIONS SARS-CoV-2 RNAemia and viral RNA load in plasma are associated with critical illness in COVID-19. Viral RNA load in plasma correlates with key signatures of dysregulated host responses, suggesting a major role of uncontrolled viral replication in the pathogenesis of this disease.
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Affiliation(s)
- Jesús F Bermejo-Martin
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Milagros González-Rivera
- Department of Laboratory Medicine, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Plaza de Ramón y Cajal, s/n, 28040, Madrid, Spain
| | - Raquel Almansa
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Dariela Micheloud
- Emergency Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Ana P Tedim
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Marta Domínguez-Gil
- Microbiology Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Salvador Resino
- Viral Infection and Immunity Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. de Pozuelo, 28, 28222, Majadahonda, Spain
| | - Marta Martín-Fernández
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Pablo Ryan Murua
- Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031, Madrid, Spain
| | - Felipe Pérez-García
- Servicio de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, Carr. de Alcalá, s/n, 28805, Madrid, Spain
| | - Luis Tamayo
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Raúl Lopez-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Elena Bustamante
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - César Aldecoa
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Department of Anesthesiology, Facultad de Medicina de Valladolid, Av. Ramón y Cajal, 47005, Valladolid, Spain
- Anesthesiology and Reanimation Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - José Manuel Gómez
- Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Jesús Rico-Feijoo
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Anesthesiology and Reanimation Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Antonio Orduña
- Microbiology Service, Hospital Clinico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Raúl Méndez
- Pulmonology Service, Hospital Universitario y Politécnico de La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Isabel Fernández Natal
- Clinical Microbiology Department, Complejo Asistencial Universitario de León, Calle Altos de Nava, s/n, 24001, León, Spain
| | - Gregoria Megías
- Microbiology Service, Hospital Universitario de Burgos, Av. Islas Baleares, 3, 09006, Burgos, Spain
| | - Montserrat González-Estecha
- Department of Laboratory Medicine, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Plaza de Ramón y Cajal, s/n, 28040, Madrid, Spain
| | - Demetrio Carriedo
- Intensive Care Unit, Complejo Asistencial Universitario de León, Calle Altos de nava, s/n, 24001, León, Spain
| | - Cristina Doncel
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Noelia Jorge
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Alicia Ortega
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Amanda de la Fuente
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Félix Del Campo
- Pneumology Service, Hospital Universitario Río Hortega/Biomedical Engineering Group, Universidad de Valladolid, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | | | - Wysali Trapiello
- Clinical Analysis Service. Hospital, Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Paula González-Jiménez
- Pulmonology Service, Hospital Universitario y Politécnico de La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Guadalupe Ruiz
- Clinical Analysis Service. Hospital, Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Alyson A Kelvin
- Department of Microbiology and Immunology, Faculty of Medicine, Canadian Center for Vaccinology CCfV, Dalhousie University, Halifax, NS, B3H 4R2, Canada
- Laboratory of Immunity, Shantou University Medical College, 22 Xinling Rd., Jinping, Shantou, Guangdong, China
| | - Ali Toloue Ostadgavahi
- Department of Microbiology and Immunology, Faculty of Medicine, Canadian Center for Vaccinology CCfV, Dalhousie University, Halifax, NS, B3H 4R2, Canada
- Laboratory of Immunity, Shantou University Medical College, 22 Xinling Rd., Jinping, Shantou, Guangdong, China
| | - Ruth Oneizat
- Microbiology Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Luz María Ruiz
- Microbiology Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Iria Miguéns
- Emergency Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Esther Gargallo
- Emergency Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Ioana Muñoz
- Emergency Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Sara Pelegrin
- Anesthesiology and Reanimation Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Silvia Martín
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Anesthesiology and Reanimation Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Pablo García Olivares
- Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Jamil Antonio Cedeño
- Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Tomás Ruiz Albi
- Pneumology Service, Hospital Universitario Río Hortega/Biomedical Engineering Group, Universidad de Valladolid, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Carolina Puertas
- Department of Laboratory Medicine, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Jose Ángel Berezo
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Gloria Renedo
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Rubén Herrán
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Juan Bustamante-Munguira
- Department of Cardiovascular Surgery, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Pedro Enríquez
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Ramón Cicuendez
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Jesús Blanco
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Jesica Abadia
- Infectious Diseases Clinic, Internal Medicine Department, Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Julia Gómez Barquero
- Infectious Diseases Clinic, Internal Medicine Department, Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Nuria Mamolar
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Natalia Blanca-López
- Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031, Madrid, Spain
| | - Luis Jorge Valdivia
- Intensive Care Unit, Complejo Asistencial Universitario de León, Calle Altos de nava, s/n, 24001, León, Spain
| | - Belén Fernández Caso
- Clinical Microbiology Department, Complejo Asistencial Universitario de León, Calle Altos de Nava, s/n, 24001, León, Spain
| | - María Ángeles Mantecón
- Microbiology Service, Hospital Universitario de Burgos, Av. Islas Baleares, 3, 09006, Burgos, Spain
| | - Anna Motos
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Department of Pulmonology, Hospital Clinic de Barcelona, Institut D Investigacions August Pi I Sunyer (IDIBAPS), Universidad de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain
| | - Laia Fernandez-Barat
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Department of Pulmonology, Hospital Clinic de Barcelona, Institut D Investigacions August Pi I Sunyer (IDIBAPS), Universidad de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain
| | - Ricard Ferrer
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Intensive Care Department, Vall d'Hebron Hospital Universitari, SODIR Research Group, Vall d'Hebron Institut de Recerca, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - Ferrán Barbé
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Respiratory Department, Institut Ricerca Biomedica de Lleida, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain
| | - Antoni Torres
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Department of Pulmonology, Hospital Clinic de Barcelona, Institut D Investigacions August Pi I Sunyer (IDIBAPS), Universidad de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain
| | - Rosario Menéndez
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Pulmonology Service, Hospital Universitario y Politécnico de La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - José María Eiros
- Microbiology Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - David J Kelvin
- Department of Microbiology and Immunology, Faculty of Medicine, Canadian Center for Vaccinology CCfV, Dalhousie University, Halifax, NS, B3H 4R2, Canada.
- Laboratory of Immunity, Shantou University Medical College, 22 Xinling Rd., Jinping, Shantou, Guangdong, China.
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Bermejo-Martin JF, González-Rivera M, Almansa R, Micheloud D, Tedim AP, Domínguez-Gil M, Resino S, Martín-Fernández M, Ryan Murua P, Pérez-García F, Tamayo L, Lopez-Izquierdo R, Bustamante E, Aldecoa C, Gómez JM, Rico-Feijoo J, Orduña A, Méndez R, Fernández Natal I, Megías G, González-Estecha M, Carriedo D, Doncel C, Jorge N, Ortega A, de la Fuente A, Del Campo F, Fernández-Ratero JA, Trapiello W, González-Jiménez P, Ruiz G, Kelvin AA, Ostadgavahi AT, Oneizat R, Ruiz LM, Miguéns I, Gargallo E, Muñoz I, Pelegrin S, Martín S, García Olivares P, Cedeño JA, Ruiz Albi T, Puertas C, Berezo JÁ, Renedo G, Herrán R, Bustamante-Munguira J, Enríquez P, Cicuendez R, Blanco J, Abadia J, Gómez Barquero J, Mamolar N, Blanca-López N, Valdivia LJ, Fernández Caso B, Mantecón MÁ, Motos A, Fernandez-Barat L, Ferrer R, Barbé F, Torres A, Menéndez R, Eiros JM, Kelvin DJ. Viral RNA load in plasma is associated with critical illness and a dysregulated host response in COVID-19. Crit Care 2020; 24:691. [PMID: 33317616 DOI: 10.1186/s13054‐020‐03398‐0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/18/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND COVID-19 can course with respiratory and extrapulmonary disease. SARS-CoV-2 RNA is detected in respiratory samples but also in blood, stool and urine. Severe COVID-19 is characterized by a dysregulated host response to this virus. We studied whether viral RNAemia or viral RNA load in plasma is associated with severe COVID-19 and also to this dysregulated response. METHODS A total of 250 patients with COVID-19 were recruited (50 outpatients, 100 hospitalized ward patients and 100 critically ill). Viral RNA detection and quantification in plasma was performed using droplet digital PCR, targeting the N1 and N2 regions of the SARS-CoV-2 nucleoprotein gene. The association between SARS-CoV-2 RNAemia and viral RNA load in plasma with severity was evaluated by multivariate logistic regression. Correlations between viral RNA load and biomarkers evidencing dysregulation of host response were evaluated by calculating the Spearman correlation coefficients. RESULTS The frequency of viral RNAemia was higher in the critically ill patients (78%) compared to ward patients (27%) and outpatients (2%) (p < 0.001). Critical patients had higher viral RNA loads in plasma than non-critically ill patients, with non-survivors showing the highest values. When outpatients and ward patients were compared, viral RNAemia did not show significant associations in the multivariate analysis. In contrast, when ward patients were compared with ICU patients, both viral RNAemia and viral RNA load in plasma were associated with critical illness (OR [CI 95%], p): RNAemia (3.92 [1.183-12.968], 0.025), viral RNA load (N1) (1.962 [1.244-3.096], 0.004); viral RNA load (N2) (2.229 [1.382-3.595], 0.001). Viral RNA load in plasma correlated with higher levels of chemokines (CXCL10, CCL2), biomarkers indicative of a systemic inflammatory response (IL-6, CRP, ferritin), activation of NK cells (IL-15), endothelial dysfunction (VCAM-1, angiopoietin-2, ICAM-1), coagulation activation (D-Dimer and INR), tissue damage (LDH, GPT), neutrophil response (neutrophils counts, myeloperoxidase, GM-CSF) and immunodepression (PD-L1, IL-10, lymphopenia and monocytopenia). CONCLUSIONS SARS-CoV-2 RNAemia and viral RNA load in plasma are associated with critical illness in COVID-19. Viral RNA load in plasma correlates with key signatures of dysregulated host responses, suggesting a major role of uncontrolled viral replication in the pathogenesis of this disease.
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Affiliation(s)
- Jesús F Bermejo-Martin
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Milagros González-Rivera
- Department of Laboratory Medicine, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Plaza de Ramón y Cajal, s/n, 28040, Madrid, Spain
| | - Raquel Almansa
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Dariela Micheloud
- Emergency Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Ana P Tedim
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Marta Domínguez-Gil
- Microbiology Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Salvador Resino
- Viral Infection and Immunity Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. de Pozuelo, 28, 28222, Majadahonda, Spain
| | - Marta Martín-Fernández
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Pablo Ryan Murua
- Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031, Madrid, Spain
| | - Felipe Pérez-García
- Servicio de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, Carr. de Alcalá, s/n, 28805, Madrid, Spain
| | - Luis Tamayo
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Raúl Lopez-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Elena Bustamante
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - César Aldecoa
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Department of Anesthesiology, Facultad de Medicina de Valladolid, Av. Ramón y Cajal, 47005, Valladolid, Spain
- Anesthesiology and Reanimation Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - José Manuel Gómez
- Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Jesús Rico-Feijoo
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Anesthesiology and Reanimation Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Antonio Orduña
- Microbiology Service, Hospital Clinico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Raúl Méndez
- Pulmonology Service, Hospital Universitario y Politécnico de La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Isabel Fernández Natal
- Clinical Microbiology Department, Complejo Asistencial Universitario de León, Calle Altos de Nava, s/n, 24001, León, Spain
| | - Gregoria Megías
- Microbiology Service, Hospital Universitario de Burgos, Av. Islas Baleares, 3, 09006, Burgos, Spain
| | - Montserrat González-Estecha
- Department of Laboratory Medicine, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Plaza de Ramón y Cajal, s/n, 28040, Madrid, Spain
| | - Demetrio Carriedo
- Intensive Care Unit, Complejo Asistencial Universitario de León, Calle Altos de nava, s/n, 24001, León, Spain
| | - Cristina Doncel
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Noelia Jorge
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Alicia Ortega
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Amanda de la Fuente
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Félix Del Campo
- Pneumology Service, Hospital Universitario Río Hortega/Biomedical Engineering Group, Universidad de Valladolid, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | | | - Wysali Trapiello
- Clinical Analysis Service. Hospital, Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Paula González-Jiménez
- Pulmonology Service, Hospital Universitario y Politécnico de La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Guadalupe Ruiz
- Clinical Analysis Service. Hospital, Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Alyson A Kelvin
- Department of Microbiology and Immunology, Faculty of Medicine, Canadian Center for Vaccinology CCfV, Dalhousie University, Halifax, NS, B3H 4R2, Canada
- Laboratory of Immunity, Shantou University Medical College, 22 Xinling Rd., Jinping, Shantou, Guangdong, China
| | - Ali Toloue Ostadgavahi
- Department of Microbiology and Immunology, Faculty of Medicine, Canadian Center for Vaccinology CCfV, Dalhousie University, Halifax, NS, B3H 4R2, Canada
- Laboratory of Immunity, Shantou University Medical College, 22 Xinling Rd., Jinping, Shantou, Guangdong, China
| | - Ruth Oneizat
- Microbiology Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Luz María Ruiz
- Microbiology Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Iria Miguéns
- Emergency Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Esther Gargallo
- Emergency Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Ioana Muñoz
- Emergency Department, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Sara Pelegrin
- Anesthesiology and Reanimation Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Silvia Martín
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Anesthesiology and Reanimation Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Pablo García Olivares
- Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Jamil Antonio Cedeño
- Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Tomás Ruiz Albi
- Pneumology Service, Hospital Universitario Río Hortega/Biomedical Engineering Group, Universidad de Valladolid, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Carolina Puertas
- Department of Laboratory Medicine, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Jose Ángel Berezo
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Gloria Renedo
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Rubén Herrán
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Juan Bustamante-Munguira
- Department of Cardiovascular Surgery, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Pedro Enríquez
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Ramón Cicuendez
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Jesús Blanco
- Intensive Care Unit, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Jesica Abadia
- Infectious Diseases Clinic, Internal Medicine Department, Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Julia Gómez Barquero
- Infectious Diseases Clinic, Internal Medicine Department, Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Nuria Mamolar
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 47003, Valladolid, Spain
| | - Natalia Blanca-López
- Hospital Universitario Infanta Leonor, Av. Gran Vía del Este, 80, 28031, Madrid, Spain
| | - Luis Jorge Valdivia
- Intensive Care Unit, Complejo Asistencial Universitario de León, Calle Altos de nava, s/n, 24001, León, Spain
| | - Belén Fernández Caso
- Clinical Microbiology Department, Complejo Asistencial Universitario de León, Calle Altos de Nava, s/n, 24001, León, Spain
| | - María Ángeles Mantecón
- Microbiology Service, Hospital Universitario de Burgos, Av. Islas Baleares, 3, 09006, Burgos, Spain
| | - Anna Motos
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Department of Pulmonology, Hospital Clinic de Barcelona, Institut D Investigacions August Pi I Sunyer (IDIBAPS), Universidad de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain
| | - Laia Fernandez-Barat
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Department of Pulmonology, Hospital Clinic de Barcelona, Institut D Investigacions August Pi I Sunyer (IDIBAPS), Universidad de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain
| | - Ricard Ferrer
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Intensive Care Department, Vall d'Hebron Hospital Universitari, SODIR Research Group, Vall d'Hebron Institut de Recerca, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - Ferrán Barbé
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Respiratory Department, Institut Ricerca Biomedica de Lleida, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain
| | - Antoni Torres
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Department of Pulmonology, Hospital Clinic de Barcelona, Institut D Investigacions August Pi I Sunyer (IDIBAPS), Universidad de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain
| | - Rosario Menéndez
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Pulmonology Service, Hospital Universitario y Politécnico de La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - José María Eiros
- Microbiology Service, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - David J Kelvin
- Department of Microbiology and Immunology, Faculty of Medicine, Canadian Center for Vaccinology CCfV, Dalhousie University, Halifax, NS, B3H 4R2, Canada.
- Laboratory of Immunity, Shantou University Medical College, 22 Xinling Rd., Jinping, Shantou, Guangdong, China.
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Hingrat QLE, Visseaux B, Laouenan C, Tubiana S, Bouadma L, Yazdanpanah Y, Duval X, Burdet C, Ichou H, Damond F, Bertine M, Benmalek N, Choquet C, Timsit JF, Ghosn J, Charpentier C, Descamps D, Houhou-Fidouh N. Detection of SARS-CoV-2 N-antigen in blood during acute COVID-19 provides a sensitive new marker and new testing alternatives. Clin Microbiol Infect 2020; 27:S1198-743X(20)30721-7. [PMID: 33307227 PMCID: PMC7724284 DOI: 10.1016/j.cmi.2020.11.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Molecular assays on nasopharyngeal swabs remain the cornerstone of COVID-19 diagnostic. The high technicalities of nasopharyngeal sampling and molecular assays, as well as scarce resources of reagents, limit our testing capabilities. Several strategies failed, to date, to fully alleviate this testing process (e.g. saliva sampling or antigen testing on nasopharyngeal samples). We assessed the clinical performances of SARS-CoV-2 nucleocapsid antigen (N-antigen) ELISA detection in serum or plasma using the COVID-19 Quantigene® (AAZ, France) assay. METHODS Performances were determined on 63 sera from 63 non-COVID patients and 227 serum samples (165 patients) from the French COVID and CoV-CONTACT cohorts with RT-PCR confirmed SARS-CoV-2 infection, including 142 serum (114 patients) obtained within 14 days after symptoms' onset. RESULTS Specificity was 98.4% (95% confidence interval [CI], 95.3 to 100). Sensitivity was 79.3% overall (180/227, 95% CI, 74.0 to 84.6) and 93.0% (132/142, 95% CI, 88.7 to 97.2) within 14 days after symptoms onset. 91 included patients had a sera and nasopharyngeal swabs collected in the same 24 hours. Among those with high nasopharyngeal viral loads, i.e. Ct value below 30 and 33, only 1/50 and 4/67 tested negative for N-antigenemia, respectively. Among those with a negative nasopharyngeal RT-PCR, 8/12 presented positive N-antigenemia; the lower respiratory tract was explored for 6 of these 8 patients, showing positive RT-PCR in 5 cases. CONCLUSION This is the first evaluation of a commercially available serum N-antigen detection assay. It presents a robust specificity and sensitivity within the first 14 days after symptoms onset. This approach provides a valuable new option for COVID-19 diagnosis, only requiring a blood draw and easily scalable in all clinical laboratories.
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Affiliation(s)
- Quentin LE Hingrat
- Université de Paris, IAME, INSERM, Paris, France; Virology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - Benoit Visseaux
- Université de Paris, IAME, INSERM, Paris, France; Virology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France.
| | - Cédric Laouenan
- Université de Paris, IAME, INSERM, Paris, France; Center for Clinical Investigation, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - Sarah Tubiana
- Université de Paris, IAME, INSERM, Paris, France; Center for Clinical Investigation, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - Lila Bouadma
- Université de Paris, IAME, INSERM, Paris, France; Medical and Infectious Diseases Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - Yazdan Yazdanpanah
- Université de Paris, IAME, INSERM, Paris, France; Tropical and infectious diseases Department, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - Xavier Duval
- Université de Paris, IAME, INSERM, Paris, France; Center for Clinical Investigation, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - Charles Burdet
- Université de Paris, IAME, INSERM, Paris, France; Center for Clinical Investigation, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - Houria Ichou
- Virology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - Florence Damond
- Université de Paris, IAME, INSERM, Paris, France; Virology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - Mélanie Bertine
- Université de Paris, IAME, INSERM, Paris, France; Virology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - Nabil Benmalek
- Virology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - Christophe Choquet
- Université de Paris, IAME, INSERM, Paris, France; Virology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
- Virology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - Jean-François Timsit
- Université de Paris, IAME, INSERM, Paris, France; Virology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
- Université de Paris, IAME, INSERM, Paris, France; Medical and Infectious Diseases Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - Jade Ghosn
- Université de Paris, IAME, INSERM, Paris, France; Virology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
- Université de Paris, IAME, INSERM, Paris, France; Tropical and infectious diseases Department, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | - Charlotte Charpentier
- Université de Paris, IAME, INSERM, Paris, France; Virology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
- Université de Paris, IAME, INSERM, Paris, France; Virology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France.
| | - Diane Descamps
- Université de Paris, IAME, INSERM, Paris, France; Virology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
- Université de Paris, IAME, INSERM, Paris, France; Virology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France.
| | - Nadhira Houhou-Fidouh
- Université de Paris, IAME, INSERM, Paris, France; Virology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France.
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75
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Cao X, Tian Y, Nguyen V, Zhang Y, Gao C, Yin R, Carver W, Fan D, Albrecht H, Cui T, Tan W. Spike Protein of SARS-CoV-2 Activates Macrophages and Contributes to Induction of Acute Lung Inflammations in Mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2020:2020.12.07.414706. [PMID: 33330865 PMCID: PMC7743069 DOI: 10.1101/2020.12.07.414706] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) patients exhibit multiple organ malfunctions with a primary manifestation of acute and diffuse lung injuries. The Spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is crucial to mediate viral entry into host cells; however, whether it can be cellularly pathogenic and contribute to pulmonary hyper-inflammations in COVID-19 is not well known. Methods and Findings In this study, we developed a Spike protein-pseudotyped (Spp) lentivirus with the proper tropism of SARS-CoV-2 Spike protein on the surface and tracked down the fate of Spp in wild type C57BL/6J mice receiving intravenous injection of the virus. A lentivirus with vesicular stomatitis virus glycoprotein (VSV-G) was used as the control. Two hours post-infection (hpi), Spp showed more than 27-75 times more viral burden in the lungs than other organs; it also exhibited about 3-5 times more viral burden than VSV-G lentivirus in the lungs, liver, kidney and spleen. Acute pneumonia was evident in animals 24 hpi. Spp lentivirus was mainly found in LDLR+ macrophages and pneumocytes in the lungs, but not in MARC1+ macrophages. IL6, IL10, CD80 and PPAR-γ were quickly upregulated in response to infection of Spp lentivirus in the lungs in vivo as well as in macrophage-like RAW264.7 cells in vitro. We further confirmed that forced expression of the Spike protein in RAW264.7 cells could significantly increase the mRNA levels of the same panel of inflammatory factors. Conclusions Our results demonstrate that the Spike protein of SARS-CoV-2 alone can induce cellular pathology, e.g. activating macrophages and contributing to induction of acute inflammatory responses.
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Affiliation(s)
- Xiaoling Cao
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Yan Tian
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Department of Obstetrics and Gynecology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Vi Nguyen
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Yuping Zhang
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Department of General Surgery, The 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chao Gao
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Rong Yin
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Wayne Carver
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Biomedical Engineering Program, College of Engineering and Computing University of South Carolina, Columbia, South Carolina, USA
| | - Daping Fan
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Biomedical Engineering Program, College of Engineering and Computing University of South Carolina, Columbia, South Carolina, USA
| | - Helmut Albrecht
- Department of Internal Medicine, Prisma Health Medical Group, Columbia, Columbia, South Carolina, USA
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Taixing Cui
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Biomedical Engineering Program, College of Engineering and Computing University of South Carolina, Columbia, South Carolina, USA
| | - Wenbin Tan
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Biomedical Engineering Program, College of Engineering and Computing University of South Carolina, Columbia, South Carolina, USA
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, Department of Neuroscience, Biomedicine and Movement, Clinical Chemistry and Laboratory Medicine, University of Verona, Verona, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, Clinical Chemistry and Laboratory Medicine, University Hospital of Padova, Padova, Italy
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77
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RNAemia Corresponds to Disease Severity and Antibody Response in Hospitalized COVID-19 Patients. Viruses 2020; 12:v12091045. [PMID: 32962125 PMCID: PMC7551174 DOI: 10.3390/v12091045] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 12/13/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents a global health emergency. To improve the understanding of the systemic component of SARS-CoV-2, we investigated if viral load dynamics in plasma and respiratory samples are associated with antibody response and severity of coronavirus disease 2019 (COVID-19). SARS-CoV-2 RNA was found in plasma samples from 14 (44%) out of 32 patients. RNAemia was detected in 5 out of 6 fatal cases. Peak IgG values were significantly lower in mild/moderate than in severe (0.6 (interquartile range, IQR, 0.4–3.2) vs. 11.8 (IQR, 9.9–13.0), adjusted p = 0.003) or critical cases (11.29 (IQR, 8.3–12.0), adjusted p = 0.042). IgG titers were significantly associated with virus Ct (Cycle threshold) value in plasma and respiratory specimens ((ß = 0.4, 95% CI (confidence interval, 0.2; 0.5), p < 0.001 and ß = 0.5, 95% CI (0.2; 0.6), p = 0.002). A classification as severe or a critical case was additionally inversely associated with Ct values in plasma in comparison to mild/moderate cases (ß = −3.3, 95% CI (−5.8; 0.8), p = 0.024 and ß = −4.4, 95% CI (−7.2; 1.6), p = 0.007, respectively). Based on the present data, our hypothesis is that the early stage of SARS-CoV-2 infection is characterized by a primary RNAemia, as a potential manifestation of a systemic infection. Additionally, the viral load in plasma seems to be associated with a worse disease outcome.
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78
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Jacobs JL, Mellors JW. Detection of SARS-CoV-2 RNA in Blood of Patients with COVID-19: What Does It Mean? Clin Infect Dis 2020; 73:e2898-e2900. [PMID: 32898242 PMCID: PMC7499541 DOI: 10.1093/cid/ciaa1316] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/07/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jana L Jacobs
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine
| | - John W Mellors
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine
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