The aim was to assess the ability of nasopharyngeal SARS-CoV-2 viral load at frst patient’s hospital
evaluation to predict unfavorable outcomes. We conducted a prospective cohort study including 321
adult patients with confrmed COVID-19 through RT-PCR in nasopharyngeal swabs. Quantitative
Synthetic SARS-CoV-2 RNA cycle threshold values were used to calculate the viral load in log10
copies/mL. Disease severity at the end of follow up was categorized into mild, moderate, and severe.
Primary endpoint was a composite of intensive care unit (ICU) admission and/or death (n= 85,
26.4%). Univariable and multivariable logistic regression analyses were performed. Nasopharyngeal
SARS-CoV-2 viral load over the second quartile (≥7.35 log10 copies/mL, p = 0.003) and second tertile
(≥ 8.27 log10 copies/mL, p = 0.01) were associated to unfavorable outcome in the unadjusted logistic
regression analysis. However, in the fnal multivariable analysis, viral load was not independently
associated with an unfavorable outcome. Five predictors were independently associated with
increased odds of ICU admission and/or death: age≥ 70 years, SpO2, neutrophils > 7.5 × 103
/µL,
lactate dehydrogenase≥ 300 U/L, and C-reactive protein≥ 100 mg/L. In summary, nasopharyngeal
SARS-CoV-2 viral load on admission is generally high in patients with COVID-19, regardless of illness
severity, but it cannot be used as an independent predictor of unfavorable clinical outcome