SARS-CoV-2 Viral Load Predicts Mortality in Patients with and Without Cancer Who are Hospitalized with Coronavirus Disease 2019

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 (C_T) values from reverse transcription-polymerase chain reaction assays applied to nasopharyngeal swab specimens in 100 patients with cancer and 2914 without cancer admitted to three New York City hospitals. Overall, the in-hospital mortality rate was 39.5% among patients with a high viral load (C_T<25), 25.6% among patients with a medium viral load (C_T 25-30), and 15.7% among patients with a low viral load (C_T>30; P<0.001). Similar findings were observed in patients with cancer (high, 45.0% mortality; medium, 29.2%; low, 13.9%; P=0.003). Patients with hematologic malignancies had higher median viral loads (C_T=25.0) than patients without cancer (C_T=29.2; P=0.0039). SARS-CoV-2 viral load results may offer vital prognostic information for patients with and without cancer who are hospitalied with COVID-19.

Funding: This work was partially supported by the National Centerfor Advancing Translational Science [UL1 TR002384 to Julianne Imperato-McGinley] at the National Institutes of Health.

Conflict of Interest: L.F.W. reports receiving consulting fees from Roche Molecular Systems, Inc. M.M.S. receives grant support from Amgen, Inc. All other authors report no potential conflicts of interest.

Ethical Approval Statement: The study was approved by the Institutional Review Board (#20-03021681) at Weill Cornell Medicine with a waiver of informed consent

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