CMAAO Coronavirus Facts and Myth Buster: Viral load and mortality

DG Alerts Excerpts:

1. High COVID-19 viral load at admission predicts mortality in hospitalized patients with and without cancer, suggests a study published in Cancer Cell.
2. Investigators assessed cycle threshold (Ct) values from PCR assays of 100 patients with cancer and 2,914 patients without cancer, admitted to 3 hospitals in New York City from March 15 through May 14, 2020.
3. The in-hospital mortality rate was 38.8% among patients with a high viral load, 24.1% among patients with a medium viral load, and 15.3% among patients with a low viral load (P< .001).
4. Among patients with cancer, those with a high viral load were shown to have a mortality rate of 45.2%, those with a medium viral load had a mortality rate of 28%, while those with a low viral load were reported to have a mortality rate of 12.1%.
5. Among patients with hematologic malignancies, median viral loads (Ct = 25.0) were higher compared to patients without cancer (Ct = 29.2).
6. The presence of hematological malignancy had an independent association with having a high viral load upon admission, compared to patients without cancer.
7. Having a solid tumor; however, was not associated with having a high viral load in univariate or multivariate analyses, in comparison with patients without cancer.
8. Among patients with active cancer, having a high viral load was independently associated with heightened in-hospital mortality.
9. The median age of entire cohort was 65 years, with 43.6% of female patients, and 78.1% non-White participants.
10. Laboratory parameters were similar between the groups, but patients with cancer had lower odds of having elevated aspartate aminotransferase levels and were more likely to have elevated procalcitonin levels than patients without cancer.
11. In addition to having a hematologic malignancy, other variables that had an independent association with having a high viral load upon admission included increased age, congestive heart failure, diabetes, chronic kidney disease, home use of inhaled, nasal, or oral steroids, residence in a nursing home or rehabilitation facility.

Author : Dr KK Aggarwal , President CMAAO, HCFI and Past National President IMA

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