Background

The viral load and tissue distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain important questions. The current study investigated SARS-CoV-2 viral load, biodistribution and anti-SARS-CoV-2 antibody formation in patients suffering from severe corona virus disease 2019 (COVID-19) induced acute respiratory distress syndrome (ARDS).

Methods

This is a retrospective single-center study in 23 patients with COVID-19-induced ARDS. Data were collected within routine intensive care. SARS-CoV-2 viral load was assessed via reverse transcription quantitative polymerase chain reaction (RT-qPCR). Overall, 478 virology samples were taken. Anti-SARS-CoV-2-Spike-receptor binding domain (RBD) antibody detection of blood samples was performed with an enzyme-linked immunosorbent assay.

Results

Most patients (91%) suffered from severe ARDS during ICU treatment with a 30-day mortality of 30%. None of the patients received antiviral treatment. Tracheal aspirates tested positive for SARS-CoV-2 in 100% of the cases, oropharyngeal swabs only in 77%. Blood samples were positive in 26% of the patients. No difference of viral load was found in tracheal or blood samples with regard to 30-day survival or disease severity. SARS-CoV-2 was never found in dialysate. Serologic testing revealed significantly lower concentrations of SARS-CoV-2 neutralizing IgM and IgA antibodies in survivors compared to non-survivors (p = 0.009).

Conclusions

COVID-19 induced ARDS is accompanied by a high viral load of SARS-CoV-2 in tracheal aspirates, which remained detectable in the majority throughout intensive care treatment. Remarkably, SARS-CoV-2 RNA was never detected in dialysate even in patients with RNAemia. Viral load or the buildup of neutralizing antibodies was not associated with 30-day survival or disease severity.

中文翻译：

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一项SARS-CoV-2诱导的ARDS的生物分布和血清学应答

背景

重症急性呼吸综合征冠状病毒2（SARS-CoV-2）的病毒载量和组织分布仍然是重要问题。本研究调查了严重冠状病毒病2019（COVID-19）诱发的急性呼吸窘迫综合征（ARDS）患者的SARS-CoV-2病毒载量，生物分布和抗SARS-CoV-2抗体形成。

方法

这是一项回顾性单中心研究，研究对象为23例COVID-19诱导的ARDS患者。在常规重症监护室收集数据。通过逆转录定量聚合酶链反应（RT-qPCR）评估SARS-CoV-2病毒载量。总体上，抽取了478份病毒学样品。用酶联免疫吸附测定法检测血液样本的抗SARS-CoV-2-Spike-受体结合域（RBD）抗体。

结果

大多数患者（91％）在ICU治疗期间患有严重的ARDS，其30天死亡率为30％。没有患者接受抗病毒治疗。气管抽吸物的SARS-CoV-2阳性率为100％，口咽拭子仅为77％。26％的患者血液样本呈阳性。在30天生存期或疾病严重程度方面，在气管或血液样本中未发现病毒载量的差异。透析液中从未发现SARS-CoV-2。血清学检查显示，幸存者中的SARS-CoV-2中和IgM和IgA抗体的浓度明显低于非幸存者（p = 0.009）。

结论

COVID-19诱导的ARDS伴有气管吸出物中SARS-CoV-2的高病毒载量，在重症监护治疗中多数仍可检测到。值得注意的是，即使在患有RNA血症的患者中，也从未在透析液中检测到SARS-CoV-2 RNA。病毒载量或中和抗体的积累与30天生存率或疾病严重程度无关。