The aim of the study titled “Excretion of SARS-CoV-2 RNA in feces has no prognostic benefit in the outcome of COVID-19: A clinical and immunological study” was to investigate the correlation between the specific anti-spike SARS-CoV-2 IgG immune response resulting from vaccination or previous infection, viral load, and fecal virus excretion, as well as their impact on the clinical characteristics and outcomes of COVID-19 among hospitalized patients during the predominance of the Omicron variant. The research included 251 patients with COVID-19 requiring hospital treatment and was conducted by a team of scientists from the University of Rijeka, Croatia, and the University of Mostar, Bosnia and Herzegovina.
The median age of admitted patients was 72 years, predominantly with pre-existing comorbidities such as arterial hypertension, cardiovascular disease, and diabetes mellitus, with 61.4% being male. Vaccinated patients developed pneumonia to a lesser extent and presented with milder clinical manifestations compared to non-vaccinated patients. Those unvaccinated and without previous infection exhibited a higher incidence of acute respiratory distress syndrome, admission to the intensive care unit, and a higher incidence of severe or critical forms of COVID-19. Specific anti-spike SARS-CoV-2 IgGs were frequently present in immunocompetent patients with lower viral loads.
Mortality occurred in 21.1% of patients, mainly among those who were immunocompromised (35.8%) and presented with severe or critical disease, which can be attributed to a weakened immune response to infection. Consistent with previous studies, study’s findings showed no correlation between the detection of SARS-CoV-2 RNA in feces and the clinical manifestations, disease severity, or outcomes of COVID-19.
Furthermore, neither the viral loads in nasopharyngeal swabs nor the presence of specific anti-spike SARS-CoV-2 IgGs, irrespective of vaccination or previous infection, influenced the level of SARS-CoV-2 RNA excretion in feces or the outcome of COVID-19. Interestingly, in one-third of the patients with SARS-CoV-2-positive nasopharyngeal swabs, SARS-CoV-2 RNA was not detected in the feces.
In conclusion, the study’s results underscore the importance of vaccination against SARS-CoV-2 in protecting patients from developing pneumonia and acute respiratory infections. However, fecal excretion of SARS-CoV-2 RNA has no impact on the clinical outcome of COVID-19, highlighting the need for caution when utilizing feces as a diagnostic sample for detecting SARS-CoV-2 infection.
The translation of the preceding English text in Bosnian:
Cilj studije pod naslovom “Izlučivanje RNK SARS-CoV-2 u fecesu nema prognostičku korist u ishodu COVID-19: Klinička i imunološka studija” bio je istražiti korelaciju između specifičnog anti-spike SARS-CoV-2 IgG imunološkog odgovora koji proizlazi iz vakcinacije ili prethodne infekcije, virusnog opterećenja, i izlučivanja virusa u fecesu, kao i njihov uticaj na kliničke karakteristike i ishode COVID-19 među hospitalizovanim pacijentima tokom dominacije varijante Omikron. Istraživanje je obuhvatilo 251 pacijenta sa COVID-19 koji su zahtijevali bolničko liječenje, i provedeno je od strane tima naučnika sa Univerziteta u Rijeci, Hrvatska, i Univerziteta u Mostaru, Bosna i Hercegovina.
Prosječna starost primljenih pacijenata bila je 72 godine, uglavnom sa prethodno postojećim komorbiditetima kao što su arterijska hipertenzija, kardiovaskularne bolesti i dijabetes melitus, pri čemu je 61,4% bilo muškaraca. Vakcinisani pacijenti razvili su upalu pluća u manjoj mjeri i imali su blaže kliničke manifestacije u poređenju sa nevakcinisanim pacijentima. Oni koji nisu bili vakcinisani i nisu imali prethodnu infekciju pokazali su veću incidenciju sindroma akutne respiratornog distresa, prijem u jedinicu intenzivne njege i veću incidenciju teških ili kritičnih oblika COVID-19. Specifična anti-spike SARS-CoV-2 IgG antitijela često su se pojavljivala kod imunokompetentnih pacijenata sa nižim virusnim opterećenjem.
Smrtnost je uočena kod 21,1% pacijenata, uglavnom među onima koji su bili imunokompromitovani (35,8%), i koji su imali tešku ili kritičnu kliničku sliku, što se može pripisati oslabljenom imunološkom odgovoru na infekciju. U skladu sa prethodnim studijama, otkrića studije su pokazala da ne postoji korelacija između detekcije RNK SARS-CoV-2 u fecesu i kliničkih manifestacija, težine bolesti ili ishoda COVID-19.
Osim toga, ni virusno opterećenje u nazofaringealnim brisevima, niti prisustvo specifičnih anti-spike SARS-CoV-2 IgG antitijela, bez obzira na vakcinaciju ili prethodnu infekciju, nisu uticali na nivo izlučivanja RNK SARS-CoV-2 u fecesu ili na ishod COVID-19. Zanimljivo je da kod jedne trećine pacijenata sa pozitivnim nazofaringealnim brisevima na SARS-CoV-2, RNK SARS-CoV-2 nije detektovana u fecesu.
Zaključno, rezultati studije naglašavaju važnost vakcinacije protiv SARS-CoV-2 u zaštiti pacijenata od razvoja upale pluća i akutnih respiratornih infekcija. Međutim, izlučivanje RNK SARS-CoV-2 u fecesu nema uticaj na klinički ishod COVID-19, ističući potrebu za oprezom prilikom korištenja fecesa kao dijagnostičkog uzorka za otkrivanje infekcije SARS-CoV-2.
Reference: Šušak B, Dalmatin-Dragišić M, Laura L, Mikulić V, Nakić K, Mikulić I, et al. Excretion of SARS-CoV-2 RNA in feces has no prognostic benefit in the outcome of COVID-19: A clinical and immunological study. Biomol Biomed [Internet]. 2024 Feb. 10 [cited 2024 Feb. 11];. Available from: https://www.bjbms.org/ojs/index.php/bjbms/article/view/10176
Editor: Ermina Vukalic
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