Viral load dynamics in intubated patients with COVID-19 admitted to the intensive care unit.

Anna G.C Boef,Lilli Gard,Peter H.J Van Der Voort,Kala Netkova,Coretta Van Leer Buter,Mariëtte Lokate,Esther M Van Wezel,Hubert G.M Niesters

doi:10.1016/j.jcrc.2021.04.010

Anna G.C Boef, Lilli Gard + Show 6 more

Open Access

https://doi.org/10.1016/j.jcrc.2021.04.010

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Abstract

BackgroundProlonged viral RNA detection in respiratory samples from patients with COVID-19 has been described, but the clinical relevance remains unclear. We studied the dynamics of SARS-CoV-2 on a group and individual level in intubated ICU patients.MethodsIn a cohort of 86 patients, we analysed SARS-CoV-2 RT-PCR results on nasopharyngeal and sputum samples (obtained as part of clinical care twice a week) according to time after intubation. Subsequently, we performed survival analyses.Results870 samples were tested by RT-PCR. Overall viral load was highest in the first week (median nasopharynx 3.5, IQR 1.5–4.3; median sputum 4.3, IQR 3.3–5.6) and decreased over time. In 20% of patients a relapsing pattern was observed. Nasopharyngeal and sputum PCR status on day 14 was not significantly associated with survival up to day 60 in this small cohort.ConclusionIn general SARS-CoV-2 RNA levels in respiratory samples in patients with severe COVID-19 decrease after the first week after intubation, but individual SARS-CoV-2 RNA levels can show a relapsing pattern. Larger studies are needed to address the association of clearance of SARS-CoV-2 RNA from respiratory samples with survival, because we observed a trend towards better survival in patients with early clearance from sputum.

Highlights

Coronavirus disease 2019 (COVID-19), caused by infection with SARS-CoV-2, has a broad clinical spectrum of disease, ranging from asymptomatic infection to severe respiratory disease requiring intensive care unit (ICU) admission and mechanical ventilation.For diagnosis of COVID-19, guidelines recommend SARS-CoV-2 nucleic acid amplification testing (NAAT) on respiratory samples [1,2]
COVID-19 patients admitted to the Intensive Care Unit (ICU) in the University Medical Center Groningen (UMCG), The Netherlands between March 24 th and May 25th 2020 and requiring invasive mechanical ventilation were included in this study
Eighty-six patients with proven COVID-19 admitted to the ICU were included in the study

Summary

Introduction

Coronavirus disease 2019 (COVID-19), caused by infection with SARS-CoV-2, has a broad clinical spectrum of disease, ranging from asymptomatic infection to severe respiratory disease requiring intensive care unit (ICU) admission and mechanical ventilation.For diagnosis of COVID-19, guidelines recommend SARS-CoV-2 nucleic acid amplification testing (NAAT) on respiratory samples (nasopharyngeal/oropharyngeal samples and sputum) [1,2]. Prolonged viral RNA detection in respiratory samples from patients with COVID-19 has been described, but the clinical relevance remains unclear. Methods: In a cohort of 86 patients, we analysed SARS-CoV-2 RT-PCR results on nasopharyngeal and sputum samples (obtained as part of clinical care twice a week) according to time after intubation. Nasopharyngeal and sputum PCR status on day 14 was not significantly associated with survival up to day 60 in this small cohort. Conclusion: In general SARS-CoV-2 RNA levels in respiratory samples in patients with severe COVID-19 decrease after the first week after intubation, but individual SARS-CoV-2 RNA levels can show a relapsing pattern. Larger studies are needed to address the association of clearance of SARS-CoV-2 RNA from respiratory samples with survival, because we observed a trend towards better survival in patients with early clearance from sputum

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