Vasopressin infusion in COVID-19 critical illness is not associated with impaired viral clearance: a pilot study

COVID-19 can progress rapidly to hypoxaemic respiratory failure and acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation. Current guidelines recommend treating these patients with lung-protective ventilation, which has a proven survival benefit in ARDS. Additional strategies used frequently in cases of severe hypoxaemia are pharmacological paralysis and prone positioning. These interventions all require heavy sedation, which in turn necessitates circulatory support with vasopressor medications. However, recent preclinical data show that molecular complexes form between the SARS-CoV-2 spike protein, soluble angiotensin-converting enzyme-2 (sACE-2), and vasopressin. These complexes facilitate cellular infection through vasopressin receptor-1b-mediated endocytosis.6 We previously showed that persistent viraemia was a feature of COVID-19 critical illness and associated with illness severity and worse outcomes. Therefore, we tested the hypothesis that vasopressin treatment could promote cellular infection and systemic viral dissemination.

In conclusion, despite preclinical data raising the possibility that vasopressin facilitates SARS-CoV-2 dissemination in vivo, we did not observe evidence of a clinically relevant effect of vasopressin infusion on viral mRNA level in a pilot cohort of critically ill patients with COVID-19 who were not treated with corticosteroids or interleukin-6 antagonists.