On-admission SARS-CoV-2 RNAemia as a single potent predictive marker of critical condition development and mortality in COVID-19

<jats:sec id="sec001"> <jats:title>Background</jats:title> <jats:p>This study aimed to clarify how SARS-CoV-2 RNAemia is related to COVID-19 critical condition development and mortality in comparison with other predictive markers and scoring systems.</jats:p> </jats:sec> <jats:sec id="sec002"> <jats:title>Methods</jats:title> <jats:p>This is a retrospective cohort study conducted at Yokohama Municipal Citizen’s Hospital and National Institute of Infectious Diseases. We recruited adult patients with COVID-19 admitted between March 2020 and January 2021. We compared RNAemia with clinical status on admission including scoring systems such as the 4C Mortality, CURB-65, and A-DROP, as well as the C<jats:sub>t</jats:sub> value of the nasopharyngeal PCR, in predicting COVID-19 mortality and critical condition development.</jats:p> </jats:sec> <jats:sec id="sec003"> <jats:title>Results</jats:title> <jats:p>Of the 92 recruited patients (median age, 58; interquartile range, 45–71 years), 14 (14.9%) had RNAemia. These patients had an older age (median, 68 years vs. 55.5 years; <jats:italic>p</jats:italic> = 0.011), higher values of lactated dehydrogenase (median, 381 U/L vs. 256.5 U/L, <jats:italic>p</jats:italic> < 0.001), C-reactive protein (median, 10.9 mg/dL vs. 3.8 mg/dL; <jats:italic>p</jats:italic> < 0.001), D-dimer (median, 2.07 μg/mL vs. 1.28 μg/mL; <jats:italic>p</jats:italic> = 0.015), lower values of lymphocyte (median, 802/μL vs. 1007/μL, <jats:italic>p</jats:italic> = 0.025) and C<jats:sub>t</jats:sub> of the nasopharyngeal PCR assay (median, 20.59 vs. 25.54; <jats:italic>p</jats:italic> = 0.021) than those without RNAemia. Univariate analysis showed RNAemia was associated with mortality (odds ratio [OR], 18.75; 95% confidence interval [CI], 3.92–89.76; area under the receiver operating characteristic curve [AUC], 0.7851; <jats:italic>p</jats:italic> = 0.002) and critical condition (OR, 72.00; 95% CI, 12.98–399.29; AUC, 0.8198; <jats:italic>p</jats:italic> < 0.001). Plus, multivariate analysis also revealed the association of RNAemia with critical condition (adjusted OR, 125.71; 95% CI, 11.47–1377.32; <jats:italic>p</jats:italic> < 0.001).</jats:p> </jats:sec> <jats:sec id="sec004"> <jats:title>Conclusion</jats:title> <jats:p>On-admission SARS-CoV-2 RNAemia is a potent predictive marker of COVID-19 critical condition and mortality. The adjusted OR for critical condition was as high as 125.71.</jats:p> </jats:sec>