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SARS-CoV-2 viral load in nasopharyngeal swabs in the emergency department does not predict COVID-19 severity and mortality.
Le Borgne, Pierrick; Solis, Morgane; Severac, François; Merdji, Hamid; Ruch, Yvon; Alamé Intern, Karine; Bayle, Eric; Hansmann, Yves; Bilbault, Pascal; Fafi-Kremer, Samira; Meziani, Ferhat.
  • Le Borgne P; Emergency Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
  • Solis M; INSERM (French National Institute of Health and Medical Research, UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, Strasbourg, France.
  • Severac F; Laboratoire de virologie, CHU de Strasbourg, Strasbourg, France.
  • Merdji H; Université de Strasbourg, INSERM, IRM UMR_S 1109, Strasbourg, France.
  • Ruch Y; Department of Public Health, University Hospital of Strasbourg, Strasbourg, France.
  • Alamé Intern K; INSERM (French National Institute of Health and Medical Research, UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, Strasbourg, France.
  • Bayle E; Faculté de Médecine, Université de Strasbourg (UNISTRA), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France.
  • Hansmann Y; Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France.
  • Bilbault P; Emergency Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
  • Fafi-Kremer S; Emergency Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
  • Meziani F; Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France.
Acad Emerg Med ; 28(3): 306-313, 2021 03.
Article in English | MEDLINE | ID: covidwho-1066580
ABSTRACT

INTRODUCTION:

The ongoing COVID-19 pandemic has led to devastating repercussions on health care systems worldwide. This viral infection has a broad clinical spectrum (ranging from influenza-like disease, viral pneumonia, and hypoxemia to acute respiratory distress syndrome requiring prolonged intensive care unit stays). The prognostic impact of measuring viral load on nasopharyngeal swab specimens (by reverse transcriptase polymerase chain reaction [RT-PCR]) is yet to be elucidated.

METHODS:

Between March 3 and April 5, 2020, we conducted a retrospective study on a cohort of COVID-19 patients (mild or severe disease) who were hospitalized after presenting to the emergency department (ED) and had at least one positive nasopharyngeal swab during their hospital stay. We led our study at the University Hospitals of Strasbourg in the Greater East region of France, one of the pandemic's epicenters in Europe.

RESULTS:

We have collected samples from a cohort of 287 patients with a confirmed diagnosis of COVID-19 who were included in our study. Nearly half of them (50.5%) presented a mild form of the disease, while the other half (49.5%) presented a severe form, requiring mechanical ventilation. Median (interquartile range) viral load on the initial upper respiratory swab at admission was 4.76 (3.29-6.06) log10 copies/reaction. When comparing survivors and nonsurvivors, this viral load measurement did not differ according to subgroups (p = 0.332). Additionally, we have found that respiratory viral load measurement was predictive of neither in-hospital mortality (adjusted odds ratio [AOR] = 1.05, 95% confidence interval [CI] = 0.85 to 1.31, p = 0.637) nor disease severity (AOR = 0.88, 95% CI = 0.73 to 1.06, p = 0.167).

CONCLUSION:

Respiratory viral load measurement on the first nasopharyngeal swab (by RT-PCR) during initial ED management is neither a predictor of severity nor a predictor of mortality in SARS-CoV-2 infection. Host response to this viral infection along with the extent of preexisting comorbidities might be more foretelling of disease severity than the virus itself.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Country/Region as subject: Europa Language: English Journal: Acad Emerg Med Journal subject: Emergency Medicine Year: 2021 Document Type: Article Affiliation country: Acem.14217

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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Country/Region as subject: Europa Language: English Journal: Acad Emerg Med Journal subject: Emergency Medicine Year: 2021 Document Type: Article Affiliation country: Acem.14217