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

43 Pages Posted: 3 Sep 2020 Publication Status: Published

See all articles by Lars F. Westblade

Lars F. Westblade

Weill Cornell Medicine - Department of Medicine

Gagandeep Brar

Cornell University - Department of Medicine

Laura Pinheiro

Weill Cornell Medicine - Department of Medicine

Demetrios Paidoussis

New York Presbyterian Hospital

Mangala Rajan

Weill Cornell Medicine - Department of Medicine

Peter Martin

Cornell University - Department of Medicine

Parag Goyal

Weill Cornell Medicine - Department of Medicine

Jorge L. Sepulveda

George Washington University - Department of Pathology

Lisa Zhang

Cornell University - Department of Medicine

Gary George

Cornell University - Department of Medicine

Dakai Liu

New York Presbyterian Hospital

Susan Whittier

Columbia University - Department of Pathology & Cell Biology

Markus Plate

Weill Cornell Medicine - Department of Medicine

Catherine B. Small

Weill Cornell Medicine - Department of Medicine

Melissa M. Cushing

Weill Cornell Medicine - Department of Pathology and Laboratory Medicine

Thomas J. Walsh

Cornell University - Department of Medicine

Joseph Cooke

Weill Cornell Medicine - Department of Medicine

Monika Safford

Weill Cornell Medicine - Department of Medicine

Massimo Loda

Harvard University - Department of Oncologic Pathology; Harvard University - Brigham and Women's Hospital

Michael J. Satlin

Cornell University - Department of Medicine

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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 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 (CT<25), 25.6% among patients with a medium viral load (CT 25-30), and 15.7% among patients with a low viral load (CT>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 (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 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

Suggested Citation

Westblade, Lars F. and Brar, Gagandeep and Pinheiro, Laura and Paidoussis, Demetrios and Rajan, Mangala and Martin, Peter and Goyal, Parag and Sepulveda, Jorge L. and Zhang, Lisa and George, Gary and Liu, Dakai and Whittier, Susan and Plate, Markus and Small, Catherine B. and Cushing, Melissa M. and Walsh, Thomas J. and Cooke, Joseph and Safford, Monika and Loda, Massimo and Satlin, Michael J., SARS-CoV-2 Viral Load Predicts Mortality in Patients with and Without Cancer Who are Hospitalized with Coronavirus Disease 2019. Available at SSRN: https://ssrn.com/abstract=3684128 or http://dx.doi.org/10.2139/ssrn.3684128
This version of the paper has not been formally peer reviewed.

Lars F. Westblade

Weill Cornell Medicine - Department of Medicine

1300 York Avenue
New York, NY 10065
United States

Gagandeep Brar

Cornell University - Department of Medicine

1300 York Avenue
P.O. Box 24144
New York, NY 10065
United States

Laura Pinheiro

Weill Cornell Medicine - Department of Medicine

Demetrios Paidoussis

New York Presbyterian Hospital ( email )

New York, NY
United States

Mangala Rajan

Weill Cornell Medicine - Department of Medicine ( email )

1300 York Avenue
P.O. Box 24144
New York, NY 10065
United States

Peter Martin

Cornell University - Department of Medicine

1300 York Avenue
P.O. Box 24144
New York, NY 10065
United States

Parag Goyal

Weill Cornell Medicine - Department of Medicine ( email )

1300 York Avenue
P.O. Box 24144
New York, NY 10065
United States

Jorge L. Sepulveda

George Washington University - Department of Pathology

2121 I Street NW
Washington, DC 20052
United States

Lisa Zhang

Cornell University - Department of Medicine

1300 York Avenue
P.O. Box 24144
New York, NY 10065
United States

Gary George

Cornell University - Department of Medicine

1300 York Avenue
P.O. Box 24144
New York, NY 10065
United States

Dakai Liu

New York Presbyterian Hospital ( email )

New York, NY
United States

Susan Whittier

Columbia University - Department of Pathology & Cell Biology

3022 Broadway
New York, NY 10027
United States

Markus Plate

Weill Cornell Medicine - Department of Medicine

1300 York Avenue
New York, NY 10065
United States

Catherine B. Small

Weill Cornell Medicine - Department of Medicine

1300 York Avenue
New York, NY 10065
United States

Melissa M. Cushing

Weill Cornell Medicine - Department of Pathology and Laboratory Medicine

1300 York Avenue
New York, NY 10065
United States

Thomas J. Walsh

Cornell University - Department of Medicine

1300 York Avenue
P.O. Box 24144
New York, NY 10065
United States

Joseph Cooke

Weill Cornell Medicine - Department of Medicine

Monika Safford

Weill Cornell Medicine - Department of Medicine ( email )

1300 York Avenue
P.O. Box 24144
New York, NY 10065
United States

Massimo Loda

Harvard University - Department of Oncologic Pathology ( email )

450 Brookline Avenue
Boston, MA 02115
United States

Harvard University - Brigham and Women's Hospital ( email )

75 Francis St.
Boston, MA 02115
United States

Michael J. Satlin (Contact Author)

Cornell University - Department of Medicine ( email )

1300 York Avenue
P.O. Box 24144
New York, NY 10065
United States

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