Prognostic Value of Severe Acute Respiratory Syndrome Coronavirus-2 Viral Load and Antibodies in Patients Hospitalized With COVID-19

Authors

Rebecca N Bauer
Anastasia Teterina
Haridha Shivram
Jacqueline McBride
Carrie M Rosenberger
Fang Cai
Min Bao
Larry Tsai
Oliver Gordon
Ivan T Lee
Jeffrey J Wallin
Danielle Porter
Kavita Juneja
Gregory Camus
Ivan O Rosas
Steffen Wildum

Publication Date

6-1-2023

Journal

Clinical and Translational Science

DOI

10.1111/cts.13511

PMID

36929625

PMCID

PMC10264938

PubMedCentral® Posted Date

3-29-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, COVID-19, SARS-CoV-2, Prognosis, Viral Load, Lung, Antibodies, Viral

Abstract

Observational studies have identified the potential prognostic value for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) viral load and anti-SARS-CoV-2 antibodies in coronavirus disease 2019 (COVID-19). However, viral load in nasopharyngeal (NP) swabs produced inconsistent results in prognostic analyses, and the prognostic value of viral load or antibodies has not been confirmed in large clinical trials. COVACTA and REMDACTA were double-blind, randomized, controlled trials with a combined enrollment of 1078 patients hospitalized with COVID-19 treated with tocilizumab or placebo in COVACTA or tocilizumab plus remdesivir or placebo plus remdesivir in REMDACTA. We assessed the potential prognostic value of NP and serum SARS-CoV-2 viral load and serum anti-SARS-CoV-2 antibodies at baseline as biomarkers for clinical outcomes in patients enrolled in these trials. In adjusted Cox proportional hazard models, serum viral load was a more reliable predictor of clinical outcomes than NP viral load; high serum viral load was associated with higher risk for death and mechanical ventilation/death and lower likelihood of hospital discharge (high vs. negative viral load hazard ratios [95% confidence interval {CI}] were 2.87 [1.57-5.25], 3.86 [2.23-6.68], and 0.23 [0.14-0.36], respectively, in COVACTA and 8.11 [2.95-22.26], 10.29 [4.5-23.55], and 0.21 [0.15-0.29], respectively, in REMDACTA) and high serum viral load correlated with levels of inflammatory cytokines and lung damage biomarkers. High anti-SARS-CoV-2 spike protein antibody (ACOV2S) levels were associated with higher likelihood of hospital discharge (high vs. below the limit of quantification hazard ratios [95% CI] were 2.55 [1.59-4.08] for COVACTA and 1.54 [1.13-2.09] for REMDACTA). These results support the role of baseline SARS-CoV-2 serum viral load and ACOV2S antibody titers in predicting clinical outcomes for patients hospitalized with COVID-19.

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