Assessment of Virological Contributions to COVID-19 Outcomes in a Longitudinal Cohort of Hospitalized Adults
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Abstract
Background
While several demographic and clinical correlates of coronavirus disease 2019 (COVID-19) outcome have been identified, their relationship to virological and immunological parameters remains poorly defined.
Methods
To address this, we performed longitudinal collection of nasopharyngeal swabs and blood samples from a cohort of 58 hospitalized adults with COVID-19. Samples were assessed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load, viral genotype, viral diversity, and antibody titer. Demographic and clinical information, including patient blood tests and several composite measures of disease severity, was extracted from electronic health records.
Results
Several factors, including male sex, higher age, higher body mass index, higher 4C Mortality score, and elevated lactate dehydrogenase levels, were associated with intensive care unit admission. Of all measured parameters, only the retrospectively calculated median Deterioration Index score was significantly associated with death. While quantitative polymerase chain reaction cycle threshold (Ct) values and genotype of SARS-CoV-2 were not significantly associated with outcome, Ct value did correlate positively with C-reactive protein levels and negatively with D-dimer, lymphocyte count, and antibody titer. Intrahost viral genetic diversity remained constant through the disease course and resulted in changes in viral genotype in some participants.
Conclusions
Ultimately, these results suggest that worse outcomes are driven by immune dysfunction rather than by viral load and that SARS-CoV-2 evolution in hospital settings is relatively constant over time.
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SciScore for 10.1101/2021.07.02.21259665: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Specimen collection and processing: After IRB approval, individuals over the age of 18 admitted to Northwestern Memorial Hospital with a positive, PCR-based COVID-19 diagnostic test, who provided informed consent themselves or through an appropriate surrogate, were enrolled in the study. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Antibodies Sentences Resources Following another three washes, plates were incubated for one hour with 100 µL/well of 1 µg/mL horseradish peroxidase conjugated goat anti-human IgG antibody, F(ab′)2 (Chemicon) in blocking buffer prior to development with … SciScore for 10.1101/2021.07.02.21259665: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Specimen collection and processing: After IRB approval, individuals over the age of 18 admitted to Northwestern Memorial Hospital with a positive, PCR-based COVID-19 diagnostic test, who provided informed consent themselves or through an appropriate surrogate, were enrolled in the study. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Antibodies Sentences Resources Following another three washes, plates were incubated for one hour with 100 µL/well of 1 µg/mL horseradish peroxidase conjugated goat anti-human IgG antibody, F(ab′)2 (Chemicon) in blocking buffer prior to development with 3,3’,5,5’-Tetramethylbenzidine (TMB) solution (Fisher). anti-human IgGsuggested: NoneAnti-Spike Antibody Quantification by ELISA: Anti-Spike IgG concentration in serum samples was determined utilizing an ELISA assay as described [37, 38]. Anti-Spike IgGsuggested: NoneA four-parameter logistic regression of the multi-concentration standard curve was obtained using CR3022, a recombinant human anti-SARS-CoV-RBD IgG antibody, with a known affinity to the RBD of SARS-CoV-2 (CR3022 antibody, Creative Biolabs #MRO-1214LC). CR3022suggested: (Imported from the IEDB Cat# CR3022, RRID:AB_2848080)anti-SARS-CoV-RBD IgGsuggested: NoneAnti-HLA Antibody Quantification: The presence of HLA Class I and Class II antibodies was measured using the FlowPRA™ Screening assay (One Lambda, A Thermo Fisher Scientific Brand), following manufacturer’s recommendation. Anti-HLAsuggested: NoneClass IIsuggested: NoneFollowing the manufacturer’s recommended protocol, plasma samples were diluted five to ten times in Tris-Buffered Saline (TBS) containing 3% BSA (w/v) before added into the microtiter plate wells containing the PAI-1 capture antibodies. PAI-1 capture antibodies.suggested: NoneAfter washing away the unbound fraction of plasma samples, the amount of PAI-1 captured in the wells was quantified after sequential binding, washing, incubation of primary antibody against PAI-1, incubation of the secondary antibody-HRP conjugate and development utilizing a TMB substrate. PAI-1suggested: Noneantibody-HRPsuggested: NoneRecombinant DNA Sentences Resources The NTD sequence was synthesized (Twist Bioscience) and cloned into pMCSG53 [35], yielding pMCSG53-N-NTD (available through BEI Resources, NR-52428). pMCSG53suggested: RRID:Addgene_167255)pMCSG53-N-NTDsuggested: NoneThe CTD sequence was synthesized (Bio Basic) and cloned into pET11a (Novagen), yielding pET11a-N-CTD (available through BEI Resources, NR-52434). pET11asuggested: RRID:Addgene_105501)pET11a-N-CTDsuggested: None, amino acids 1-412), pET-28a(+) containing the entire Wuhan-Hu-1 Nucleocapsid open reading frame was obtained from BEI Resources (NIAID, NIH, Catalog # NR-53507) and transformed into E. coli Rosetta-1 cells (Novagen). pET-28a(+ )suggested: NoneSoftware and Algorithms Sentences Resources Barcode sequences were trimmed from aligned reads and consensus sequence determined using iVar v1.2.2 [33] with a minimum alignment depth of 10 reads and minimum base quality of 20, and a consensus frequency threshold of 0 (i.e. majority base as the consensus). iVarsuggested: NoneCoated plates were washed three times with 250 µL of wash buffer (1x PBS with 0.5% Tween-20) using a Thermo Fisher Wellwash™ Thermo Fisher Wellwash™suggested: (Thermo Scientific Wellwash Wellwash, RRID:SCR_020569)Phylogenetic Analysis: Consensus sequences for all longitudinal samples from each participant were aligned using MAFFT v7.453 software and manually edited using MEGA v6.06. MAFFTsuggested: (MAFFT, RRID:SCR_011811)MEGAsuggested: (Mega BLAST, RRID:SCR_011920)A Maximum Likelihood (ML) phylogeny with all consensus sequences were inferred with IQ-Tree v2.0.5 using its ModelFinder function before each analysis to estimate the nucleotide substitution model best-fitted for each dataset by means of Bayesian information criterion (BIC). IQ-Treesuggested: (IQ-TREE, RRID:SCR_017254)We used QuasiRecomb [40] to perform a probabilistic inference of the viral haplotypes per gene present in each viral population. QuasiRecombsuggested: (QuasiRecomb, RRID:SCR_008812)After haplotype reconstruction, we discarded sequences with less than 1% frequency of the reads to avoid including sequencing errors and we calculated the pairwise genetic distance between every haplotype and the most predominant haplotype using DistanceCalculator in biopython 1.74. DistanceCalculatorsuggested: Nonebiopythonsuggested: (Biopython, RRID:SCR_007173)To obtain the number of nonsynonymous substitutions per non-synonymous site (dN) and the number of synonymous substitutions per synonymous site (dS), we followed a similar approach using CodonSeq and cal_dn_ds with the NG86 method from biopython 1.74. CodonSeqsuggested: NoneAll calculations were performed using in-house scripts in python 3.8 (available upon request). pythonsuggested: (IPython, RRID:SCR_001658)Both PCA and agglomerative hierarchical clustering were performed using FactoMineR package and factoextra was used for visualization of the clustering results. FactoMineRsuggested: (FactoMineR, RRID:SCR_014602)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Despite its strengths, this study has several limitations. This is a single center study and as such our population may be different from the general population. That said, during this phase of the pandemic, we were a tertiary referral hospital that continued to accept patients from both our usual catchment area but also referrals in from other hospitals around the Chicagoland area. The study included the first wave of the pandemic and as such there was significant variability in the therapies that were given to the participants. That said, few of the participants received therapies that were subsequently found to be clinically beneficial. As such, the experience reflects the natural history of illness with general supportive measures. Nevertheless, continued exploration of the trends observed here in larger, multi-institutional cohorts is required. Lastly, the study did not include a non-hospitalized control group for comparison and utility of the identified markers to predict hospitalization or other outcomes cannot be assessed. In sum, this study found that the 4C mortality score and LDH levels at the time of admission were predictive of admission to the ICU and should be examined in larger cohorts for use in clinical risk management. Validation of a novel score based on BMI, lymphocyte count, and neutrophil count on admission may yield a useful tool for predicting outcomes of hospitalized patients. While not assessed in this study, the role of these factors and others to ...
Results from TrialIdentifier: No clinical trial numbers were referenced.
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- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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