Diabetes and High SARS-CoV-2 Viral Load a Deadly Combination in ICU Patients

NEW YORK (Reuters Health) – In COVID-19 patients, a high viral load (SARS-CoV-2 RNAemia) on admission to the intensive-care unit (ICU) is common in patients with diabetes and strongly associated with poor outcome, suggests a study from France.

Using the droplet-based digital polymerase chain reaction (ddPCR) for precise quantification of plasma SARS-CoV-2 viral load, they determined the relationship between plasma viral load, comorbidities and mortality in 122 critically ill COVID-19 patients admitted to the ICU.

SARS-CoV-2 RNAemia was detected in 90 (74%) patients, ranging from 70 to 213,152 copies/ml, report Dr. Mehran Monchi of Melun-Senart Hospital Center, in Melun, and colleagues in iScience.

Forty-six patients (38%) had high (>1,000 copies/ml) or very high (>10,000 copies/ml) SARS-Cov-2 RNAemia, and more than half of these patients were diabetic (57%). Diabetes was independently associated with a higher SARS-CoV-2 RNAemia.

On multivariable analysis, the intensity of SARS-CoV-2 RNAemia was “strongly and independently” associated with day-60 mortality, with an odds ratio of 2.45 or 3.53, depending on the model, per 10-fold increase above 316 copies/mL.

The team notes that in the SARS-CoV-2 disease process, after a period of respiratory worsening and ICU admission, the importance of viral replication rate remains still unclear.

It’s been suggested that during the secondary period of respiratory worsening, treatments for COVID-19 have less to do with viral replication and more to do with controlling inflammation.

Dr. Monchi and colleagues say their findings do not support this notion and suggest that “early initiation of antiviral therapies might be considered in COVID-19 critically ill patients with high RNAemia.”

A limitation of the study is that plasma viral RNA levels were analyzed only at the time of ICU admission, with no data on viral load dynamics over time before and after ICU admission.

Nonetheless, they say this “single parameter at admission had important prognosis value and might lead to new therapeutic strategies.”

SOURCE: https://bit.ly/37KUON9 iScience, online March 14, 2022.

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