Daily monitoring of viral load measured as SARS-CoV-2 antigen and RNA in blood, IL-6, CRP and complement C3d predicts outcome in patients hospitalized with COVID-19

Claus Lohman Brasen*, Henry Christensen, Dorte A. Olsen, Søren Kahns, Rikke F. Andersen, Jeppe B. Madsen, Amanda Lassen, Helene Kierkegaard, Anders Jensen, Thomas V. Sydenham, Jonna S. Madsen, Jens K. Møller, Ivan Brandslund

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

We hypothesized that the amount of antigen produced in the body during a COVID-19 infection might differ between patients, and that maximum concentrations would predict the degree of both inflammation and outcome for patients. Eighty-four hospitalized and SARS-CoV-2 PCR swab-positive patients, were followed with blood sampling every day until discharge or death. A total of 444 serial EDTA plasma samples were analyzed for a range of biomarkers: SARS-CoV-2 nuclear antigen and RNA concentration, complement activation as well as several inflammatory markers, and KL-6 as a lung marker. The patients were divided into outcome groups depending on need of respiratory support and death/survival. Circulating SARS-CoV-2 nuclear antigen levels were above the detection limit in blood in 65 out of 84 COVID-19 PCR swab-positive patients on day one of hospitalization, as was viral RNA in plasma in 30 out of 84. In all patients, complete antigen clearance was observed within 24 days. There were definite statistically significant differences between the groups depending on their biomarkers, showing that the concentrations of virus RNA and antigen were correlated to the inflammatory biomarker levels, respiratory treatment and death. Viral antigen is cleared in parallel with the virus RNA levels. The levels of antigens and SARS-CoV-2 RNA in the blood correlates with the level of IL-6, inflammation, respiratory failure and death. We propose that the antigens levels together with RNA in blood can be used to predict the severity of disease, outcome, and the clearance of the virus from the body.

Original languageEnglish
JournalClinical Chemistry and Laboratory Medicine
Volume59
Issue number12
Pages (from-to)1988-1997
ISSN1434-6621
DOIs
Publication statusPublished - 25. Nov 2021

Bibliographical note

Publisher Copyright:
© 2021 Walter de Gruyter GmbH, Berlin/Boston.

Keywords

  • biomarkers
  • correlation
  • COVID-19
  • prognosis
  • severity

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