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Friday, 04/28/2023
The viral load of COVID-19 at admission to the ICU determines the prognosis of patients
The viral load of COVID-19 at admission to the ICU
determines the prognosis of patients
· One in three patients presented a 'viral storm', showing signs of a greater inflammatory response.
· The study has been led by the CIBER-ISCIII together with the Biomedical Research Institute of Salamanca, the Rio Hortega University Hospital, the Hospital Clínic of Barcelona, the Biomedical Research Institute of Lleida, the Carlos III Health Institute and the Dalhousie University
Madrid, April 26, 2023. New research reveals the importance of 'viral storm' in critical patients with COVID-19. The work is published in the journal The Lancet Microbe and has been carried out by several groups in the area of Respiratory Diseases (CIBERES) and the area of Infectious Diseases (CIBERINFEC) of the Biomedical Research Center in Network (CIBER)consortium attached to the Carlos III Health Institute (ISCIII). The results show that viral load in blood at admission to the ICU is a determining factor in the prognosis of critical patients with COVID-19.
The CIBER researchers who led the study -belonging to the CIBERESUCICOVID project (*) of the COVID Fund- Instituto de Salud Carlos III- Antoni Torres, Ferrán Barbé, Jesús Bermejo, Anna Motos and Salvador Resino, along with Nadia García-Mateo (IBSAL) and David J. Kelvin de la (Dalhousie University of Canada), observed that the higher load of viral RNA in plasma presented patients with COVID-19 at admission to the ICU, there was a higher risk of mortality.
Specifically, a group of patients presenting a 'viral storm', characterized by the massive release of ribonucleic acid (RNA) and SARS-CoV-2 proteins in blood, was identified and that, Upon admission to the ICU, they had not produced enough antibodies against the S protein of the virus, showing signs of a greater inflammatory response. This group represents a third of the 836 critical patients with COVID-19 of a cohort recruited during the first year of pandemic in 23 UCIs across the country. And these were not only those with the highest mortality rate (half died within 90 days of admission), but they also had significant complications: 94% needed invasive mechanical ventilation, 41% suffered acute renal failure and and 65% developed secondary infections.
Therefore, it is demonstrated that patients with COVID-19 who are not able to control the virus have the worst prognosis, and that the inflammatory response in these patients is directly related to the intensity of viral replication. It is revealed that the key to prevent complications of COVID-19 in patients with risk factors lies in the early control of the virus, a fundamental principle that could be applied not only to future pandemics caused by emerging viruses, but also the viruses responsible for seasonal epidemics.
That is where the "main value of the study" resides, in the words of Jesús Bermejo, principal investigator of the CIBERES belonging to the Biomedical Research Institute of Salamanca and the University Hospital Río Hortega of Valladolid, which explains: "It helps us to better understand the true primary cause of severe COVID-19, which is the inability of some patients to control the virus, demonstrated by the passage of large amounts of viral material into the blood. These are patients who, because of their advanced age or the presence of other diseases such as diabetes, have difficulty producing antibodies (and probably cellular immunity) against the virus".
The project, led by CIBERES together with the Biomedical Research Institute of Salamanca, the Hospital Clínic of Barcelona and the Biomedical Research Institute of Lleida, has involved a great multidisciplinary effort in which more than 80 intensive physicians and translational researchers from 23 UCIs from all over Spain have collaborated, among which are experts from the CYBER Infectious Diseases (CIBERINFEC).
The study used state-of-the-art technologies funded by CIBERES and ISCIII, such as the QX200 digital PCR platforms and SimplePlex biomarker quantification.
Vaccination, key to reducing the 'viral storm'
Antoni Torres, principal investigator of CIBERES belonging to the Pulmonology Service of the Hospital Clínic of Barcelona, states that the results "demonstrate the importance of vaccination, especially in fragile patients, as well as early treatment with antivirals when these patients become infected, in order to prevent them from developing this 'viral storm'. However, it notes that there are patients who, because they are immunosuppressed, do not respond well to vaccines, and that "in them we have to implement active strategies of early treatment with antivirals, to avoid this intensity of viral replication".
Ferrán Barbé, scientific director of CIBERES at the Biomedical Research Institute of Lleida (IRBLleida), adds that it will also be important "to study the impact of this viral storm on the long-term consequences of the disease in critical patients who survived the virus".
(*) THE PROJECT CIBERESUCICOVID
The study CIBERESUCICOVID, led by researcher Antoni Torres, group leader of the CIBER of Respiratory Diseases (CIBERES) of the ISCIII in the Clinical Hospital of Barcelona, determines the risk and prognostic factors of patients infected with COVID-19 who are admitted to the Spanish Intensive Care Units (ICU) since the pandemic began in Spain until it ends. The study is possible thanks to the help that CIBER received from the COVID-19 Fund, which was granted by ISCIII to support research projects that will improve the clinical approach of COVID-19. In addition, the CIBERES-UCI-COVID plus project, funded by ISCIII-UNESPA, which aims to identify molecular factors associated with poor prognosis and long-term complications in these patients, also contributed to this work.
ABOUT THE CIBER
The Networked Biomedical Research Centre (CIBER) is a public consortium attached to the Carlos III Health Institute (Ministry of Science and Innovation) and is co-financed by the European Regional Development Fund (ERDF). Its objective is to promote research excellence in biomedicine and health sciences carried out in the National Health System and the Science and Technology System. At present, CIBER has more than 500 research groups and a staff of nearly 6,000 research staff assigned and hired from more than 100 consortia.
Reference of the article:
Effect of viral storm in patients admitted to intensive care units with severe COVID-19 in Spain: a multicentre, prospective, cohort study
https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(23)00041-1/fulltext
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