SARS-CoV-2 viremia and COVID-19 mortality: A prospective observational study

Andrea Giacomelli; Elena Righini; Valeria Micheli; Pietro Pinoli; Anna Bernasconi; Alberto Rizzo; Letizia Oreni; Anna Lisa Ridolfo; Spinello Antinori; Stefano Ceri; Giuliano Rizzardini

doi:10.1371/journal.pone.0281052

SARS-CoV-2 viremia and COVID-19 mortality: A prospective observational study

PLoS One. 2023 Apr 28;18(4):e0281052. doi: 10.1371/journal.pone.0281052. eCollection 2023.

Authors

Affiliations

¹ Dipartimento di Malattie Infettive, ASST-FBF-Sacco, Milano, Italia.
² Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Milano, Italia.
³ Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST-FBF-Sacco, Milan, Italy.
⁴ Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Milano, Italia.

Abstract

Background: SARS-CoV-2 viremia has been found to be a potential prognostic factor in patients hospitalized for COVID-19.

Objective: We aimed to assess the association between SARS-CoV-2 viremia and mortality in COVID-19 hospitalized patients during different epidemic periods.

Methods: A prospective COVID-19 registry was queried to extract all COVID-19 patients with an available SARS-CoV-2 viremia performed at hospital admission between March 2020 and January 2022. SARS-CoV-2 viremia was assessed by means of GeneFinderTM COVID-19 Plus RealAmp Kit assay and SARS-CoV-2 ELITe MGB® Kit using <45 cycle threshold to define positivity. Uni and multivariable logistic regression model were built to assess the association between SARS-CoV-2 positive viremia and death.

Results: Four hundred and forty-five out of 2,822 COVID-19 patients had an available SARS-CoV-2 viremia, prevalently males (64.9%) with a median age of 65 years (IQR 55-75). Patients with a positive SARS-CoV-2 viremia (86/445; 19.3%) more frequently presented with a severe or critical disease (67.4% vs 57.1%) when compared to those with a negative SARS-CoV-2 viremia. Deceased subjects (88/445; 19.8%) were older [75 (IQR 68-82) vs 63 (IQR 54-72)] and showed more frequently a detectable SARS-CoV-2 viremia at admission (60.2% vs 22.7%) when compared to survivors. In univariable analysis a positive SARS-CoV-2 viremia was associated with a higher odd of death [OR 5.16 (95% CI 3.15-8.45)] which was confirmed in the multivariable analysis adjusted for age, biological sex and, disease severity [AOR 6.48 (95% CI 4.05-10.45)]. The association between positive SARS-CoV-2 viremia and death was consistent in the period 1 February 2021-31 January 2022 [AOR 5.86 (95% CI 3.43-10.16)] and in subgroup analysis according to disease severity: mild/moderate [AOR 6.45 (95% CI 2.84-15.17)] and severe/critical COVID-19 patients [AOR 6.98 (95% CI 3.68-13.66)].

Conclusions: SARS-CoV-2 viremia resulted associated to COVID-19 mortality and should be considered in the initial assessment of COVID-19 hospitalized patients.

Copyright: © 2023 Giacomelli et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Observational Study

MeSH terms

Aged
COVID-19*
Hospitalization
Humans
Male
Middle Aged
Prospective Studies
SARS-CoV-2
Viremia

Grants and funding

AG has received consultancy fees from Mylan and Jansen, and non-financial educational support and a research grant from Gilead sciences and ViiV Healthcare. GR received grants, fees for speaker’s bureau, advisory boards and CME activities from BMS, ViiV, MSD, AbbVie, Gilead, Janssen and Roche. SA received support for research activities from Pfizer and Merck Sharp & Dome. All other authors have nothing to declare The founders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.