Correlation of SARS-CoV-2 Nasopharyngeal CT Values With Viremia and Mortality in Adults Hospitalized With COVID-19.

Background: Both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viremia and nasopharyngeal viral load have been suggested to be predictors of unfavorable outcome in coronavirus disease 2019 (COVID-19). This study aimed to investigate whether nasopharyngeal viral load is correlated with viremia and unfavorable outcome. Methods: The presence of SARS-CoV-2 RNA was determined in paired nasopharyngeal and serum samples collected at admission from patients hospitalized for COVID-19. Standardized cycle threshold values (CT values) were used as an indicator of viral load. An adjusted logistic regression was used to estimate the risk of viremia at different nasopharyngeal CT values. A Cox regression was used to estimate the risk of 60-day mortality. Results: A total of 688 patients were included. Viremia at admission was detected in 63% (146/230), 46% (105/226), and 31% (73/232) of patients with low, intermediate, and high nasopharyngeal CT values. The adjusted odds ratios of being viremic were 4.4 (95% CI, 2.9-6.8) and 2.0 (95% CI, 1.4-3.0) for patients with low and intermediate CT values, compared with high CT values. The 60-day mortality rate was 37% (84/230), 15% (36/226), and 10% (23/232) for patients with low, intermediate, and high nasopharyngeal CT values at admission, respectively. Adjusted hazard ratios were 2.6 (95% CI, 1.6-4.2) and 1.4 (95% CI, 0.8-2.4) for patients with low and intermediate CT values compared with high CT values. Conclusions: There was a dose-dependent correlation between nasopharyngeal CT values and viremia at admission for COVID-19. Moreover, there was an increased risk of 60-day mortality for patients with low, compared with high, nasopharyngeal CT values.

Impaired Microvascular Function in Patients With Critical COVID-19.

Severe coronavirus disease 2019 is characterized by infected microvascular endothelial cells. The primary aim of this study was to investigate microvascular function in patients with critical coronavirus disease 2019. DESIGN: A prospective observational study was conducted in which patients with critical and severe COVID-19 were investigated during acute disease phase and at least 3 months after disease onset. SETTING: Single-center study at Danderyd University Hospital. PATIENTS: Twenty-three patients with critical coronavirus disease 2019 treated with noninvasive or invasive mechanical ventilation, seven patients with severe COVID-19 with dyspnea or need of oxygen supply up to 8 L/min, and 15 noncoronavirus disease controls. INTERVENTIONS: None. MEASUREMENTS: Skin perfusion was investigated through laser speckle contrast imaging before and after iontophoresis of acetylcholine and sodium nitroprusside for determination of the endothelial-dependent and the endothelial-independent vasodilation, respectively. MAIN RESULTS: Patients with critical COVID-19 had higher basal skin perfusion during both the acute (34 ± 9 perfusion unit; p = 0.0003) and the postinfectious phase (29 ± 8 perfusion unit; p = 0.04), compared with noncoronavirus disease controls (23 ± 7 perfusion unit). In addition, endothelial-dependent and endothelial-independent vasodilation were reduced in patients with critical COVID-19 during the acute disease phase (p < 0.001 for both), whereas no significant differences between patients and controls were found during the postinfectious phase. In patients with severe COVID-19, basal skin perfusion and endothelial-dependent vasodilatation were not significantly changed, whereas endothelial-independent vasodilatation was reduced (p = 0.02) compared with controls. CONCLUSIONS: Changes in skin microcirculation in patients with critical COVID-19 indicate that the infection induces a systemic microvascular impairment with persisting long-term effects on the microvascular function.

Severe Acute Respiratory Syndrome Coronavirus 2 RNA in Serum as Predictor of Severe Outcome in Coronavirus Disease 2019: A Retrospective Cohort Study.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19). This study aimed to determine if SARS-CoV-2 RNA in serum at admission correlated with clinical outcome in COVID-19. METHODS: COVID-19 patients admitted to the infectious diseases department of a tertiary level Swedish hospital and sampled for SARS-CoV-2 RNA in serum at admission during 10 April to 30 June 2020 were included. Primary outcomes were day 28 all-cause mortality and progress to critical disease. RESULTS: The cohort (N = 167) consisted of 106 SARS-CoV-2 RNA serum-negative and 61 serum-positive patients. Median sampling time for initial SARS-CoV-2 in serum was 1 day (interquartile range [IQR], 1-2 days) after admission, corresponding to day 10 (IQR, 8-12) after symptom onset. Median age was 53 years (IQR, 44-67 years) and 63 years (IQR, 52-74 years) for the serum-negative and -positive patients, respectively. In the serum-negative and -positive groups, 3 of 106 and 15 of 61 patients died, respectively.The hazard ratios for critical disease and all-cause mortality were 7.2 (95% confidence interval [CI], 3.0-17) and 8.6 (95% CI, 2.4-30), respectively, for patients with serum-positive compared to serum-negative results. CONCLUSIONS: SARS-CoV-2 RNA in serum at hospital admission indicates a high risk of progression to critical disease and death.

Microvascular Dysfunction in Patients with Critical Covid-19, a Pilot Study.

BACKGROUND: Endothelial and microvascular dysfunction may be a key pathogenic feature of severe COVID-19. The aim of this study was to investigate endothelial-dependent and endothelial-independent skin microvascular reactivity in patients with critical COVID-19. METHODS: Twelve patients with COVID-19 treated with non-invasive or invasive mechanical ventilation were included in the study. We investigated skin microvascular reactivity on 2 separate days during hospitalization (study day 1 and 2) and at least 3 months after disease onset (study day 3). Twelve controls with no confirmed or suspected COVID-19 infection during 2020 were also examined. Skin perfusion was investigated through Laser Speckle Contrast Imaging before and after iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP) to determine the endothelial-dependent and the endothelial-independent vasodilation, respectively. RESULTS: Compared to controls, patients with critical COVID-19 had higher basal skin perfusion and reduced responses to endothelial-dependent (ACh, P = 0.002) and endothelial-independent (SNP, P = 0.01) vasodilator drugs on study day 1. In addition, the ACh/SNP ratio was significantly reduced in patients (0.50 ±â€Š0.36 vs. 0.91 ±â€Š0.49 in controls, P = 0.02). Three months after disease onset, surviving patients tended to have reduced ACh-mediated vasodilation compared to controls (P = 0.08). CONCLUSIONS: This small-sized pilot study demonstrates that critical COVID-19 infection is associated with microvascular impairment and, in particular, a markedly reduced endothelial function. Our results also suggest that microvascular function may not be fully recovered 3 months after disease onset.

Risk factors for death in adult COVID-19 patients: Frailty predicts fatal outcome in older patients.

OBJECTIVES: This study investigated demographics, comorbidities, and death rate in hospitalized patients with confirmed COVID-19. In addition, we hypothesized that functional status, according to the Clinical Frailty Scale (CFS), in patients aged 65 years or older is a better predictor of poor outcome than age and comorbidities. METHODS: A total of 255 randomly selected COVID-19 patients admitted to a university hospital were included and followed up for 60 days. Patient data were extracted manually from the electronic health records with use of a standardized protocol. RESULTS: The age of the study population ranged between 20 and 103 years (mean age 66 years ± 17 years). Hypertension, diabetes mellitus, and obesity were the three most prevalent comorbidities. At the 60-day follow-up, 70 patients (27%) had died. In multivariate analyses, age, chronic kidney disease, and previous stroke were associated with death. Most fatal cases (90%) occurred in patients aged 65 years or older. Among such patients, CFS level was the only predictor of death in multivariate analyses. CONCLUSIONS: This study shows that increasing age, chronic kidney disease, and previous stroke significantly contribute to a fatal outcome in hospitalized patients with COVID-19. In patients aged 65 years or older, CFS level was the strongest prognostic factor for death.