Impact of Baseline SARS-CoV-2 Load in Plasma and Upper Airways on the Incidence of Acute Extrapulmonary Complications of COVID-19: A Multicentric, Prospective, Cohort Study.

Autor:	Jensen TO; Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark., Harper K; Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, Minnesota, USA., Gupta S; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA.; Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA., Liu ST; Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Dharan NJ; Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia., Baker JV; Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA.; Division of Infectious Diseases, Hennepin Healthcare, Minneapolis, Minnesota, USA., Pett SL; The Medical Research Council Clinical Trials Unit at UCL, University College London, London, United Kingdom., Shaw-Saliba K; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA., Esmail A; Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa., Ho MQ; Department of Infectious Diseases, Orlando VA Medical Center, Orlando, Florida, USA., Almasri E; Department of Pulmonology, University of California San Francisco, Fresno, California, USA., Dewar RL; Virus Isolation and Serology Laboratory, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA., Lundgren J; Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark., Vock DM; Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, Minnesota, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2024 Dec 17; Vol. 79 (6), pp. 1394-1403.
DOI:	10.1093/cid/ciae469
Abstrakt:	Background: Extrapulmonary complications (EPCs) are common in patients hospitalized for coronavirus disease 2019 (COVID-19), but data on their clinical consequences and association with viral replication and systemic viral dissemination are lacking. Methods: Patients hospitalized for COVID-19 and enrolled in the Therapeutics for Inpatients with COVID-19 (TICO) platform trial at 114 international sites between August 2020 and November 2021 were included in a prospective cohort study. We categorized EPCs into 39 event types within 9 categories and estimated their frequency through day 28 and their association with clinical outcomes through day 90. We analyzed the association between baseline viral burden (plasma nucleocapsid antigen [N-Ag] level and upper airway viral load) and EPCs, adjusting for other baseline factors. Results: A total of 2625 trial participants were included in the study. Their median age was 57 years (interquartile range, 46-68 years), 57.7% were male, and 537 (20.5%) had ≥1 EPC. EPCs were associated with higher day-90 all-cause mortality rate (hazard ratio, 9.6 [95% confidence interval, 7.3-12.7]) after adjustment for other risk factors. The risk of EPCs increased with increasing baseline plasma N-Ag level (hazard ratio, 1.21 per log10 ng/L increase [95% confidence interval, 1.09-1.34]), and upper airway viral load (1.12 per log10 copies/mL increase [1.04-1.19), after adjustment for comorbid conditions, disease severity, inflammatory markers, and other baseline factors. Trial treatment allocation had no effect on EPC risk. Conclusions: Systemic viral dissemination as evidenced by high plasma N-Ag level and high respiratory viral burden are associated with development of EPCs in COVID-19, which in turn are associated with higher 90-day mortality rates. Competing Interests: Potential conflicts of interest. N. J. D. received institutional funding from Gilead Sciences. S. L. P. reports institutional grants from the National Institute for Health and Care Research, the European and Developing Countries Clinical Trials Partnership, the Medical Research Council, Gilead Sciences, Janssen-Cilag, and ViiV Healthcare and also serves as a member of the data and safety monitoring board for the TIPAL trial. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze:	MEDLINE
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