Вирусная РНК в крови

[chuka_lis]

Согласно исследованиям испанских врачей: отличным маркером тяжести ковида-19 является измерение количества вирусной РНК в крови больных.
Чем ее больше, тем тяжелее протекает заболевание.

Виремия положительно коррелирует и с другими маркерами (или факторами риска) воспаления и тяжести течения- старший возраст, низкие уровни насыщения крови кислородом, высокие уровни лактат-дегидрогеназы, С-реактивного белка и прокальцитонина, тяжелой лимфопенией.
Опираясь на этот показатель, можно спрогнозировать, выживет больной или нет.
От меня:
Наличие связи между количеством вируса в крови и тяжестью болезни, вообще-то, говорит, что не только слишком сильный иммунный ответ является причиной развивающейся патологии, а если и он, то не беспочвенно- а из-за того что вируса много, и он везде. Или, еще вариант- вирус находится в клетках крови (лимфоциты и моноциты, например)- и чем больше их заражено вирусом (=больше определяется вируса), тем хуже картина.

Our objective was to analyse SARS-CoV-2 RNA detection in serum as a severity biomarker in COVID-19. Methods and Findings Retrospective observational study including 193 patients admitted for COVID-19. Detection of SARS-CoV-2 RNA in serum (CoVemia) was performed with samples collected at 48-72 hours of admission ..Main outcome variables were mortality and need for ICU admission during hospitalization for COVID-19. CoVemia was detected in 50-60% of patients depending on technique.
Recently, detection of SARS-CoV-2 RNA in blood has been suggested as a potential severity biomarker [12,13,16–18]. In this regard, our results reinforce these previous data with a main contribution to the management of COVID-19: we have determined a semiquantitative thresholdforSARS-CoV-2 RNA detection in serum early after admission that allows establishing RNA values(“relevant CoVemia”)associated with higher mortality risk. Furthermore, we have shown that, technically,this finding is reproducible and, it is the most useful biomarker in the clinical setting for predicting mortality in COVID-19 patients.
From a clinical point of view,we have shown that CoVemia has a high consistence as a severity biomarker in COVID-19, since it correlates with several variables that have been proposed to be associated with poorevolution in COVID-19, namely old age, comorbidity, qSOFA and CURB-65, as well as with laboratory markers such as high IL-6 or LDH serum levels and severe lymphopenia. Furthermore, multivariable Cox regression analysis identified high LDH serum levels and relevant CoVemia as independent and solid predictors for mortality after adjusting by age, sex,and presence of comorbidity. Neither qSOFA,CURB-65, low total lymphocyte count,nor high IL-6 serum levels maintained354statistically significant association with mortality.

Patients with CoVemia were older (p = 0.006), had poorer baseline oxygenation (PaO2/FiO2; p < 0.001), more severe lymphopenia (p < 0.001) and higher LDH (p < 0.001), IL-6 (p = 0.021), C-reactive protein (CRP; p = 0.022) and procalcitonin (p = 0.002) serum levels. We defined "relevant CoVemia" when detection Ct was < 34 with Roche and < 31 for TFS. These thresholds had 95% sensitivity and 35 % specificity. Relevant CoVemia predicted death during hospitalization (OR 9.2 [3.8 - 22.6] for Roche, OR 10.3 [3.6 - 29.3] for TFS; p < 0.001). Cox regression models, adjusted by age, sex and Charlson index, identified increased LDH serum levels and relevant CoVemia (HR = 9.87 [4.13-23.57] for TFS viremia and HR = 7.09 [3.3-14.82] for Roche viremia) as the best markers to predict mortality