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. 2020 Nov 9;38(5):661-671.e2.
doi: 10.1016/j.ccell.2020.09.007. Epub 2020 Sep 15.

SARS-CoV-2 Viral Load Predicts Mortality in Patients with and without Cancer Who Are Hospitalized with COVID-19

Lars F Westblade  1 , Gagandeep Brar  2 , Laura C Pinheiro  3 , Demetrios Paidoussis  4 , Mangala Rajan  3 , Peter Martin  2 , Parag Goyal  2 , Jorge L Sepulveda  5 , Lisa Zhang  3 , Gary George  3 , Dakai Liu  4 , Susan Whittier  6 , Markus Plate  2 , Catherine B Small  2 , Jacob H Rand  7 , Melissa M Cushing  7 , Thomas J Walsh  2 , Joseph Cooke  8 , Monika M Safford  2 , Massimo Loda  7 , Michael J Satlin  9
Affiliations

SARS-CoV-2 Viral Load Predicts Mortality in Patients with and without Cancer Who Are Hospitalized with COVID-19

Lars F Westblade et al. Cancer Cell. .

Abstract

Patients with cancer may be at increased risk of severe coronavirus disease 2019 (COVID-19), but the role of viral load on this risk is unknown. We measured SARS-CoV-2 viral load using cycle threshold (CT) values from reverse-transcription polymerase chain reaction assays applied to nasopharyngeal swab specimens in 100 patients with cancer and 2,914 without cancer who were admitted to three New York City hospitals. Overall, 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 < 0.001). Similar findings were observed in patients with cancer (high, 45.2% mortality; medium, 28.0%; low, 12.1%; p = 0.008). Patients with hematologic malignancies had higher median viral loads (CT = 25.0) than patients without cancer (CT = 29.2; p = 0.0039). SARS-CoV-2 viral load results may offer vital prognostic information for patients with and without cancer who are hospitalized with COVID-19.

Keywords: cancer; coronavirus disease 2019 (COVID-19); cycle threshold (C(T)); hematologic malignancy; mortality; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); solid tumor; viral load.

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Conflict of interest statement

Declaration of Interests L.F.W. reports receiving consulting and grant support from Roche Molecular Systems, Inc. M.M.S. receives grant support from Amgen, Inc. All other authors declare no competing interests.

Figures

None
Graphical abstract
Figure 1
Figure 1
Flow Diagram of Patients Included in the Study and Reasons for Exclusion
Figure 2
Figure 2
Admission SARS-CoV-2 CT Values in Patients with Solid Tumors, with Hematologic Malignancies, and without Active Cancer (A) These CT values are of the SARS-CoV-2-specific gene _target (ORF1ab or N2) derived from nasopharyngeal swab specimens obtained upon admission to the hospital, stratified by whether the patient had no active cancer, a solid tumor, or a hematologic malignancy; (B) SARS-CoV-2-specific gene _target CT values displayed by type of cancer. The most common other solid tumors were thoracic (n = 5) and gynecologic (n = 4), and the most common other hematologic malignancies were lymphoma (n = 6) and acute leukemia (n = 4); (C) SARS-CoV-2-specific gene _target CT values among patients with solid tumors and hematologic malignancies who received chemotherapy or _targeted therapies and among those who did not receive these therapies. Median values are represented by horizontal lines and boxes represent 25th–75th percentiles. The Wilcoxon rank-sum test was used for viral load comparisons with two-sided p values.
Figure 3
Figure 3
Probability of In-Hospital Survival Over Time Among Patients with Cancer Stratified by Admission Viral Load Viral loads are grouped into categories based on CT values of the SARS-CoV-2-specific gene _target (cobas SARS-CoV-2 assay, ORF1ab: high, CT < 25; medium, CT 25–30, low, CT > 30; and Xpert Xpress SARS-CoV-2 assay, N2: high, CT < 27; medium, CT 27–32, low, CT > 32). Hazard ratios (HR) were generated using a Cox proportional hazards model with two-sided p values.
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