RNAemia Corresponds to Disease Severity and Antibody Response in Hospitalized COVID-19 Patients

Viruses. 2020 Sep 18;12(9):1045. doi: 10.3390/v12091045.

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents a global health emergency. To improve the understanding of the systemic component of SARS-CoV-2, we investigated if viral load dynamics in plasma and respiratory samples are associated with antibody response and severity of coronavirus disease 2019 (COVID-19). SARS-CoV-2 RNA was found in plasma samples from 14 (44%) out of 32 patients. RNAemia was detected in 5 out of 6 fatal cases. Peak IgG values were significantly lower in mild/moderate than in severe (0.6 (interquartile range, IQR, 0.4-3.2) vs. 11.8 (IQR, 9.9-13.0), adjusted p = 0.003) or critical cases (11.29 (IQR, 8.3-12.0), adjusted p = 0.042). IgG titers were significantly associated with virus Ct (Cycle threshold) value in plasma and respiratory specimens ((ß = 0.4, 95% CI (confidence interval, 0.2; 0.5), p < 0.001 and ß = 0.5, 95% CI (0.2; 0.6), p = 0.002). A classification as severe or a critical case was additionally inversely associated with Ct values in plasma in comparison to mild/moderate cases (ß = -3.3, 95% CI (-5.8; 0.8), p = 0.024 and ß = -4.4, 95% CI (-7.2; 1.6), p = 0.007, respectively). Based on the present data, our hypothesis is that the early stage of SARS-CoV-2 infection is characterized by a primary RNAemia, as a potential manifestation of a systemic infection. Additionally, the viral load in plasma seems to be associated with a worse disease outcome.

Keywords: SARS-CoV-2; antibodies; blood; dynamics; humoral response; seroconversion; viral load; viremia.

MeSH terms

  • Aged
  • Antibodies, Viral / blood*
  • Betacoronavirus / genetics
  • Betacoronavirus / immunology
  • Betacoronavirus / isolation & purification*
  • COVID-19
  • Coronavirus Infections / blood
  • Coronavirus Infections / pathology
  • Coronavirus Infections / virology*
  • Female
  • Germany / epidemiology
  • Hospitalization
  • Humans
  • Immunoglobulin G / blood
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / blood
  • Pneumonia, Viral / pathology
  • Pneumonia, Viral / virology*
  • RNA, Viral / analysis
  • RNA, Viral / blood*
  • Respiratory System / virology
  • SARS-CoV-2
  • Severity of Illness Index
  • Viral Load
  • Viremia / blood
  • Viremia / pathology
  • Viremia / virology

Substances

  • Antibodies, Viral
  • Immunoglobulin G
  • RNA, Viral