Corticosteroid, oseltamivir and delayed admission are independent risk factors for prolonged viral shedding in patients with Coronavirus Disease 2019

Abstract

Introduction Coronavirus Disease 2019 (COVID‐19) has spread worldwide, and it has reached to more than 14.5 million cases. Although Hubei province is the epicenter of China, little is known about epidemiological and clinical features of COVID‐19 in other areas in Hubei province around Wuhan. In addition, the virological data, particularly the factors associated with viral shedding of COVID‐19 has not been well described. Objective To describe the epidemiological and clinical features of patients with COVID‐19 in Tianmen city, and identify risk factors associated with prolonged viral shedding of COVID‐19. Methods Inpatients with COVID‐19 admitted before February 9, 2020 were included. Characteristics were compared between patients with early and late viral RNA shedding. Multivariate cox regression model was used to investigate variables associated with prolonged viral shedding. Results One hundred and eighty‐three patients were included. About 8.2% patients were categorized as critical degree of severity. All patients received antiviral therapy, with arbidol and interferon being the commonest. About 38.3% and 16.9% patients were treated with corticosteroid and immunoglobulin, respectively. Time from onset to admission (HR = 0.829, P < 0.001), and administration of corticosteroid (HR = 0.496, P = 0.002), arbidol (HR = 2.605, P = 0.008) and oseltamivir (HR = 0.416, P < 0.001) were independently associated with duration of viral shedding. Conclusion Symptoms of patients from Tianmen are relatively mild. Treatment should be started as early as possible, but corticosteroid and oseltamivir should be initiated with caution. In addition, clinical trials on arbidol should be conducted to demonstrate its effectiveness.

A Novel Prediction Model for Long-Term SARS-CoV-2 RNA Shedding in Non-Severe Adult Hospitalized Patients with COVID-19: A Retrospective Cohort Study

“…Previous studies have found several factors to be associated with prolonged shedding. These include older age, male sex, concomitant hypertension or diabetes, delayed admission to hospital after illness onset, severe illness at admission, invasive mechanical ventilation, administration of corticosteroid, and so on [ 12 , 14 – 17 ]. In the study by Zhou et al, multivariable regression showed prolonged viral shedding independently associated with older age (odds ratio 1.02, p = 0.003) [ 12 ].…”

“…In the study by Zhou et al, multivariable regression showed prolonged viral shedding independently associated with older age (odds ratio 1.02, p = 0.003) [ 12 ]. Another study reported time from onset to admission (HR = 0.829, p < 0.001), and administration of corticosteroid (HR = 0.496, p = 0.002), arbidol (HR = 2.605, p = 0.008) and oseltamivir (HR = 0.416, p < 0.001) were independently associated with duration of viral shedding [ 14 ]. In a retrospective study, risk factors associated with SARS-CoV-2 RNA shedding were evaluated in a cohort of 113 symptomatic patients from two hospitals outside Wuhan, and the results showed that prolonged SARS-CoV-2 RNA shedding was associated with male sex, old age, concomitant hypertension, delayed admission to hospital after illness onset, severe illness at admission, invasive mechanical ventilation, and corticosteroid treatment [ 15 ].…”

“…In a previous retrospective study, the median duration of SARS-CoV-2 RNA detection was 17 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22) days as measured from illness onset [15]. Liu et al reported the median duration of viral shedding was 25.0 days (IQR 20.0-30.0) in 140 medical workers with COVID-19 in Wuhan, China [18].…”

Factors that Influence the Duration of Symptom Resolution in COVID-19 Patients in Ethiopia: A Follow up Study Involving 60 Symptomatic Cases.

“…According to studies from Beijing and Wuhan, the median duration of recovery from the virus after symptoms resolution is 2.5 days and 8 days [19,20]. This indicates that patients continued to be virus positive even after the resolution of symptoms Some of the studies conducted in China and western countries, revealed that older age, delayed initiation of antiviral treatment, highest temperature at admission, male sex, CHD co-morbidity, decreased albumin levels were among important factors that affect the duration of shedding of the virus [11,14,16,21]. Corticosteroid treatment has also been indicated as predictors of longer duration of clearing of the virus from the body [12], however, another study claimed that low-to-moderate dosage of corticosteroid had little effect on the duration of viral excretion [11].…”

Factors that influence the duration of symptom resolution in COVID-19 patients in Ethiopia: A follow up study involving 60 symptomatic cases.&nbsp;

“…According to studies from Beijing and Wuhan, the median duration of recovery from the virus after symptoms resolution is 2.5 days and 8 days [19,20]. This indicates that patients continued to be virus positive even after the resolution of symptoms Some of the studies conducted in China and western countries, revealed that older age, delayed initiation of antiviral treatment, highest temperature at admission, male sex, CHD co-morbidity, decreased albumin levels were among important factors that affect the duration of shedding of the virus [11,14,16,21].…”