• Hans-Kittil Viermyr, Bente Halvorsen, Ellen Lund Sagen, Annika E Michelsen, Andreas Barrat-Due, Trine Kåsine, Katerina Nezvalova-Henriksen, Anne Ma Dyrhol-Riise, Nor‐Solidarity Consortium, Tøri Vigeland Lerum, Fredrik Müller, Kristian Tonby, Anders Tveita, Pål Aukrust, Marius Trøseid, Thor Ueland, and Tuva Børresdatter Dahl.
• Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
• J. Intern. Med. 2024 Sep 1; 296 (3): 249259249-259.

ObjectivesTo investigate temporal changes in the association between SARS-CoV2 viral load (VL) and markers of inflammation during hospitalization, as well as the ability of these markers alone or in combination to predict severe outcomes.MethodsSerial oropharyngeal and blood samples were obtained from hospitalized COVID-19 patients (n = 160). Levels of inflammatory markers and oropharyngeal VL were measured during hospitalization (admission, days 3-5, and days 7-10) and related to severe outcomes (respiratory failure/intensive care unit admission).ResultsElevated admission levels of IL (interleukin)-6, IL-33, IL-8, monocyte chemoattractant protein-1 (MCP-1), interferon-γ-induced protein 10 (IP-10), IL-1β, and IL-1Ra were associated with severe outcomes during hospitalization. Although no inflammatory markers correlated with VL at baseline, there was a significant correlation between VL and levels of IP-10 and MCP-1 at days 3-5, accompanied by IL-8 and IL-6 at days 7-10. Finally, there was a seemingly additive effect of IP-10, MCP-1, and IL-6 in predicting severe outcomes when combined with high VL at baseline.ConclusionsAn increasing number of inflammatory markers were associated with VL during the first 10 days of hospitalization, and several of these markers were associated with severe outcomes, in particular when combined with elevated VL. Future studies should assess the potential for combining antiviral and immunomodulatory treatment, preferably guided by viral and inflammatory biomarkers, for the selection of high-risk patients.© 2024 The Author(s). Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.

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