• Manuela Rizzi, Filippo Patrucco, Morena Trevisan, Giulia Faolotto, Alessio Mercandino, Chiara Strola, Paolo Ravanini, Martina Costanzo, Stelvio Tonello, Erica Matino, Giuseppe F Casciaro, Alessandro Croce, Eleonora Rizzi, Erika Zecca, Anita Pedrinelli, Veronica Vassia, Raffaella Landi, Mattia Bellan, Luigi M Castello, Rosalba Minisini, Venkata R Mallela, Gian C Avanzi, Mario Pirisi, Daniele Lilleri, Paolo Solidoro, Francesco Gavelli, and Pier P Sainaghi.
• Unit of Rheumatology, Maggiore della Carità University Hospital, Novara, Italy.
• Panminerva Med. 2022 Dec 1; 64 (4): 465471465-471.

BackgroundSARS-CoV-2 is a single-stranded RNA virus, known to be the causative agent of COVID-19. As the resulting disease shows a very heterogeneous range of clinical manifestations, the identification of early biomarkers allowing patients stratification according to the expected disease severity is still an unmet clinical need.MethodsIn this observational prospective cohort study, 137 consecutive patients, testing positive for SARS-CoV-2 infection by nasopharyngeal swab RT-PCR or antigenic test, were enrolled to evaluate their plasma viral load at the time of hospitalization.ResultsEven if all of them had a molecular diagnosis of COVID-19, only 29 patients showed a detectable plasma SARS-CoV-2 RNAemia. Such viremic patients also showed other clinical and laboratory finding alterations (increased troponin I, IL-6, RDW-CV, and creatinine levels along with decreased platelet count and glomerular filtration rate). A plasma detectable RNA viral load predicted in hospital death or ICU admission with an odds ratio of 3.53 (CI: 1.44-8.64, P=0.0058), while the lack of a detectable viral load was associated with a faster recovery, with an odds ratio of 4.06 (CI: 1.72-9.59, P=0.0014). These findings were confirmed in multivariate models including age, sex and baseline National Early Warning Score 2 and arterial oxygen tension over inspired oxygen fraction ratio.ConclusionsOur data thus suggest that plasma viral RNA load at the time of hospital admission could represent a useful independent biomarker allowing early patients' stratification according to the expected disease evolution, and driving clinical decisions tailored on the specific needs of the individual patient.

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