COVID-19 has overloaded national health services worldwide. Thus, early identification of patients at risk of poor outcomes is critical. Our objective was to analyse SARS-CoV-2 RNA detection in serum as a severity biomarker in COVID-19. Retrospective observational study including 193 patients admitted for COVID-19. Detection of SARS-CoV-2 RNA in serum (viremia) was performed with samples collected at 48–72 h of admission by two techniques from Roche and Thermo Fischer Scientific (TFS). Main outcome variables were mortality and need for ICU admission during hospitalization for COVID-19. Viremia was detected in 50–60% of patients depending on technique. The correlation of Ct in serum between both techniques was good (intraclass correlation coefficient: 0.612; p < 0.001). Patients with viremia were older (p = 0.006), had poorer baseline oxygenation (PaO 2 /FiO 2 ; p < 0.001), more severe lymphopenia (p < 0.001) and higher LDH (p < 0.001), IL-6 (p = 0.021), C-reactive protein (CRP; p = 0.022) and procalcitonin (p = 0.002) serum levels. We defined "relevant viremia" when detection Ct was < 34 with Roche and < 31 for TFS. These thresholds had 95% sensitivity and 35% specificity. Relevant viremia predicted death during hospitalization (OR 9.2 [3.8–22.6] for Roche, OR 10.3 [3.6–29.3] for TFS; p < 0.001). Cox regression models, adjusted by age, sex and Charlson index, identified increased LDH serum levels and relevant viremia (HR = 9.87 [4.13–23.57] for TFS viremia and HR = 7.09 [3.3–14.82] for Roche viremia) as the best markers to predict mortality. Viremia assessment at admission is the most useful biomarker for predicting mortality in COVID-19 patients. Viremia is highly reproducible with two different techniques (TFS and Roche), has a good consistency with other severity biomarkers for COVID-19 and better predictive accuracy.
【저자키워드】 Biomarkers, Risk factors, Microbiology, Diseases, 【초록키워드】 COVID-19, Biomarker, Mortality, Hospitalization, IL-6, severity, LDH, Sex, C-reactive protein, risk, detection, procalcitonin, outcome, observational study, lymphopenia, serum, sensitivity, specificity, Viremia, Accuracy, Patient, ICU admission, death, age, SARS-CoV-2 RNA, correlation, threshold, Roche, Admission, Critical, predict, COVID-19 patients, marker, SARS-CoV-2 RNA detection, Oxygenation, best, Predictive, National Health Services, Health Service, Charlson index, Older, Serum level, technique, serum levels, National, Cox regression models, Thermo Fischer Scientific, variable, defined, predicted, collected, was performed, adjusted, baseline, PaO, 【제목키워드】 risk, detection, hospitalized COVID-19 patient, increased mortality,