{"doi":"10.1093/cid/ciae469","title":"Impact of Baseline SARS-CoV-2 Load in Plasma and Upper Airways on the Incidence of Acute Extrapulmonary Complications of COVID-19: A Multicentric, Prospective, Cohort Study","abstract":"BACKGROUND: Extrapulmonary complications (EPCs) are common in patients hospitalized for coronavirus disease 2019 (COVID-19), but data on their clinical consequences and association with viral replication and systemic viral dissemination are lacking. METHODS: Patients hospitalized for COVID-19 and enrolled in the Therapeutics for Inpatients with COVID-19 (TICO) platform trial at 114 international sites between August 2020 and November 2021 were included in a prospective cohort study. We categorized EPCs into 39 event types within 9 categories and estimated their frequency through day 28 and their association with clinical outcomes through day 90. We analyzed the association between baseline viral burden (plasma nucleocapsid antigen [N-Ag] level and upper airway viral load) and EPCs, adjusting for other baseline factors. RESULTS: A total of 2625 trial participants were included in the study. Their median age was 57 years (interquartile range, 46-68 years), 57.7% were male, and 537 (20.5%) had ≥1 EPC. EPCs were associated with higher day-90 all-cause mortality rate (hazard ratio, 9.6 [95% confidence interval, 7.3-12.7]) after adjustment for other risk factors. The risk of EPCs increased with increasing baseline plasma N-Ag level (hazard ratio, 1.21 per log10 ng/L increase [95% confidence interval, 1.09-1.34]), and upper airway viral load (1.12 per log10 copies/mL increase [1.04-1.19), after adjustment for comorbid conditions, disease severity, inflammatory markers, and other baseline factors. Trial treatment allocation had no effect on EPC risk. CONCLUSIONS: Systemic viral dissemination as evidenced by high plasma N-Ag level and high respiratory viral burden are associated with development of EPCs in COVID-19, which in turn are associated with higher 90-day mortality rates.","journal":"Clinical Infectious Diseases","year":2024,"id":460078,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7664,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1288105,"name":"Katrina Harper","orcid":null,"position":1,"is_corresponding":false},{"id":901102,"name":"Shaili Gupta","orcid":"0000-0001-9508-0995","position":2,"is_corresponding":false},{"id":104928,"name":"Sean Liu","orcid":"0000-0002-3842-6838","position":3,"is_corresponding":false},{"id":899706,"name":"Nila J. Dharan","orcid":"0000-0003-1175-5962","position":4,"is_corresponding":false},{"id":501460,"name":"Jason V. Baker","orcid":"0000-0002-5542-1545","position":5,"is_corresponding":false},{"id":647503,"name":"Sarah Pett","orcid":"0000-0002-4851-4727","position":6,"is_corresponding":false},{"id":242114,"name":"Kathryn Shaw‐Saliba","orcid":"0000-0002-4396-2432","position":7,"is_corresponding":false},{"id":528805,"name":"Aliasgar Esmail","orcid":"0000-0002-1835-9252","position":8,"is_corresponding":false},{"id":1287577,"name":"Minh Q Ho","orcid":"0000-0001-7509-6156","position":9,"is_corresponding":false},{"id":624834,"name":"Eyad Almasri","orcid":null,"position":10,"is_corresponding":false},{"id":432708,"name":"Robin Dewar","orcid":"0000-0002-7840-3155","position":11,"is_corresponding":false},{"id":12038,"name":"Jens Lundgren","orcid":"0000-0001-8901-7850","position":12,"is_corresponding":false},{"id":353741,"name":"David M. Vock","orcid":"0000-0002-5459-9579","position":13,"is_corresponding":false},{"id":846594,"name":"Tomas Ø. Jensen","orcid":"0000-0003-0398-4431","position":0,"is_corresponding":true}],"reference_count":33,"raw_metadata":null,"created_at":"2026-07-19T02:04:03.568045Z","pmid":"39271151","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}