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Factores asociados con el desarrollo de ARNemia por SARS-CoV-2 en el diagnóstico de COVID-19

Javier Martín-Escolano¹, Ana Ruiz-Molina¹, Cristina Rodríguez-Urbistondo¹

¹Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Instituto de Biomedicina de Sevilla (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain.

|August 21, 2025

Resumen

La inmunodeficiencia aumenta significativamente el riesgo de ARNemia por el SARS-CoV-2. Factores como las variantes virales, los biomarcadores de la inflamación y la respuesta inmune afectan el desarrollo de la ARNemia tanto en individuos inmunocomprometidos como inmunocompetentes.

Área de la Ciencia:

Virología
Inmunología
Epidemiología

Sus antecedentes:

La ARNemia del SARS-CoV-2 en el momento del diagnóstico está relacionada con un aumento de la mortalidad.
La identificación de los factores que contribuyen a la ARNemia es crucial para el tratamiento del paciente.

Objetivo del estudio:

Determinar los factores asociados con el desarrollo de la ARNemia por SARS-CoV-2.
Analizar estos factores en grupos de pacientes inmunocomprometidos y inmunocompetentes.

Principales métodos:

Se realizó un estudio de cohorte COVID-19 multicéntrico desde enero de 2020 hasta mayo de 2023.
Los datos recogidos incluyeron datos demográficos, comorbilidades, signos clínicos, valores de laboratorio, citoquinas y anticuerpos neutralizantes.
La ARNemia fue el criterio de valoración primario.

Principales resultados:

La ARNemia se produjo en el 49,7% de los pacientes inmunocomprometidos frente al 18,7% de los pacientes inmunocompetentes (p < 0,001).
En pacientes inmunocomprometidos, la ARNemia se asoció con períodos de la variante Omicron, neumonía, elevación de la LDH y ausencia de anticuerpos neutralizantes.
En pacientes inmunocompetentes, la ARNemia se relacionó con los períodos de la variante Delta/ Omicron, la linfopenia y los niveles elevados de LDH.

Conclusiones:

La inmunodeficiencia casi triplica el riesgo de ARNemia por el SARS-CoV-2.
Las variantes virales (Omicron), la LDH como marcador inflamatorio y la disminución de la respuesta inmune (anticuerpos neutralizantes o linfopenia) son factores clave.
La neumonía en pacientes inmunocomprometidos también contribuye al desarrollo de la RNAemia.

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