Viral load and gastrointestinal inflammation in COVID-19 patients

Background: ACE-2 receptors are well-known as binding receptors to spike protein of SARS-CoV-2 highly expressed in the gastrointestinal system. The Role of SARS-CoV-2 viral load and its effect on gut inflammation in COVID-19 patients are still not well-understood. This study aims to determine the impact of SARS-CoV-2 viral load on gastrointestinal inflammation. Methods: : A total of 44 inpatient subjects who fulfilled eligibility criteria were examined for cycle threshold values from nasopharyngeal swab samples collected from several nucleic levels based on fluorescence signal and calprotectin levels of stool samples using Calprotectin enzyme-linked immunosorbent assay (ELISA) kit. Results: : Of 44 subjects, 52.3% were male, with a median age of 52.5 years. Hypertension or diabetes was found in 26 patients. The median cycle threshold value was 31.3 with a value range of 10.9-40.0, median cycle threshold was significantly lower in subjects with comorbidity with P = 0.01. The median fecal calprotectin level was 42 μg/g with a value range of 5.1-1,393.7 μg/g, with median fecal calprotectin significantly higher in subjects with gastrointestinal symptoms with P = 0.008 with a relative risk (RR) of 5.5. There was a significant correlation between cycle threshold and fecal calprotectin in subjects with comorbidity with P <0.05, a coefficient contingency of 0.414. Conclusion: Subjects with comorbidity are prone to have higher viral loads paralleled with gastrointestinal inflammation. Subjects with overt gastrointestinal manifestations had a five-fold higher degree of gut inflammation.