Factors associated with SARS-CoV-2 RNAemia development at COVID-19 diagnosis

by Javier Martín-Escolano, Ana Ruiz-Molina, Cristina Rodríguez-Urbistondo, Carmen Infante-Domínguez, Gabriela Abelenda-Alonso, Gorane Euba, Zaira R. Palacios-Baena, Francisco Arnaiz-Revillas, Jorge Alba, Alexander Rombauts, Regino J. Rodríguez-Álvarez, Natalia Maldonado, Claudia González-Rico, Sonia Santibañez, Marta Carretero-Ledesma, Laura Merino, Jordi Carratalá, Ane Josune Goikoetxea-Agirre, Marta Fernández-Martínez, José Antonio Oteo, María Carmen Fariñas, Jesús Rodríguez-Baño, José Miguel Cisneros, Belén Gutiérrez-Gutiérrez, Rocío Álvarez-Marín, Manuela Aguilar-Guisado, Sonsoles Salto-Alejandre, Elisa Cordero, Jerónimo Pachón, Javier Sánchez-Céspedes

Objectives

SARS-CoV-2 RNAemia at diagnosis is associated with mortality. The aims were to identify factors associated with the development of RNAemia.

Methods

Multicenter COVID-19 cohort study was conducted between January 2020 and May 2023. Demographics, chronic underlying diseases, symptoms and signs, analytical and radiological variables, cytokines, and neutralizing antibodies were evaluated on admission. RNAemia was the primary endpoint.

Results

We included 1011 patients, 392 (38.8%) immunocompromised and 619 (61.2%) immunocompetent. RNAemia occurred in 49.7% and 18.7% (p < 0.001), respectively, being independently associated with 30-day all-cause mortality. In immunocompromised patients, factors independently associated with RNAemia were Alpha and Omicron VOC periods (OR: 1.95 [1.01–3.79]), pneumonia (OR: 1.96 [1.10–3.50]), LDH > 300 UI/L (OR: 1.64 [1.02–2.63]) and neutralizing antibodies absence (OR: 2.51 [1.57–4.00]). In immunocompetent patients, the factors associated with RNAemia were Delta and Omicron VOC periods (OR: 2.27 [1.46–3.52]), lymphocyte count < 1000/µL (OR: 1.81 [1.16–2.80]) and LDH levels > 300 IU/L (OR: 3.99 [2.51–6.36]).

Conclusions

Immunodeficiency almost tripled SARS-CoV-2 RNAemia. Omicron VOC period, LDH as inflammatory biomarker, and a lower immune response in all patients, neutralizing antibodies absence in immunocompromised and lymphopenia in immunocompetent, and pneumonia in immunocompromised patients were associated with RNAemia.