Relationship Between serum SARS-CoV-2 nucleic acid(RNAemia) and Organ Damage in COVID-19 Patients: A Cohort Study

Xu, Dan; Zhou, Fuling; Sun, Wenbo; Chen, Liangjun; Lan, Lan; Li, Huan; Xiao, Feng; Li, Ying; Kolachalama, Vijaya B; Li, Yirong; Wang, Xinghuan; Xu, Haibo

BACKGROUND: SARS-CoV-2 has spread worldwide and has the ability to damage multiple organs. However, information on serum SARS-CoV-2 nucleic acid(RNAemia) in patients affected by COVID-19 is limited. METHODS: Patients who admitted to Zhongnan Hospital of Wuhan University with laboratory-confirmed COVID-19, were tested SARS-COV-2 RNA in serum from January 28, 2020, to February 9, 2020. Demographic data, laboratory findings, radiological, comorbidities and outcomes data were collected and analyzed. RESULTS: 85 patients were included in the analysis. The viral load of throat swabs was significantly higher than serum samples. The highest detection of SARS-CoV-2 RNA in serum samples was between 11 to 15 days after the symptom onset. Analysis to compare with and without RNAemia provided evidence that CT and some laboratory biomarkers(total protein, BUN, LDH, hypersensitive troponin I and D-dimer) were abnormal, and that the extent of these abnormalities was generally higher in RNAemia than in non-RNAemia. Organ damages(respiratory failure, cardiac damage, renal damage and coagulopathy) were more common in RNAemia than non-RNAemia. Patients with vs without RNAemia had shorter durations from serum testing SARS-CoV-2 RNA. The mortality rate was higher among patients with vs without RNAemia. CONCLUSIONS: This study provides evidence to support that SARS-CoV-2 may have an important role in multiple organ damage, such as respiratory failure, cardiac damage, renal damage and coagulopathy. We did not find strong evidence that SARS-CoV-2 plays a role in damage of liver and the central nervous system. And our evidence suggests that RNAemia has a significant association with a higher risk of in-hospital mortality.