Factors associated with delayed viral shedding in COVID-19 infected patients: A retrospective small-scale study

Abstract

Background: The outbreak of COVID-19 has caused ever-increasing attention and public panic all over the world. Until now, data are limited about the risk factors to virus shedding in COVID-19 infected patients. Methods: In this retrospective study, data were collected from 87 patients hospitalized with COVID-19 infection in Suzhou. Using Cox proportional hazards regression and Kaplan-Meier survival analysis, the risk factors to COVID-19 RNA shedding was to be established according to demographic information, clinical characteristics, epidemiological history, antiviral medicine and corticosteroid administration. Results: The median duration of COVID-19 RNA shedding from admission was 13.11 ± 0.76 days. There was no significant difference in viral shedding duration in terms of gender, age, history of Hubei province stay, characteristics of chest CT on admission, lymphocytopenia and clinical severity. By Cox proportional hazards model, excessive 200 mg cumulative corticosteroid (HR, 3.425 [95% CI, 1.339-7.143]), time from illness onset to hospitalization (<5 days) (HR, 2.503 [95% CI, 1.433-4.371]) and arbidol-included therapy (HR, 2.073 [95% CI, 1.185-3.626]) were the independent risk factors to delay COVID-19 RNA shedding. Besides of excessive 200 mg of cumulative corticosteroid (HR, 2.825 [95% CI, 1.201-6.649]), admission within 5 days from illness onset (HR, 2.493 [95% CI, 1.393-4.462]) and arbidol-included therapy (HR, 2.102 [95% CI, 1.073-4.120]), lymphocytopenia (HR, 2.153 [95% CI, 1.097-4.225]) was further identified as another unfavorable factor to 10-day viral shedding. Conclusions: The potential risk factors could help clinicians to identify patients with delayed viral shedding, thereby providing the rational strategy of treatment and optimal anti-viral interventions.

Early Corticosteroid Initiation Delays Viral RNA Clearance in Respiratory Secretions of COVID-19 Patients

“…Previous studies have demonstrated that a cumulative dose of methylprednisolone more than 200 mg could suppress the immune cells resulting in prolonged severe acute respiratory syndrome coronavirus 2 shedding in patients with coronavirus disease 2019 (COVID-19) pneumonia [1,2]. In our study, we further confirm an association between early corticosteroid use and delayed viral shedding in COVID-19 patients.…”

Clinical features and independent predictors for recurrence of positive SARS‐CoV‐2 RNA: A propensity score‐matched analysis

“…This result indicates that with the delaying of virus shedding duration, the risk of SARS-CoV-2 RNA recurrence positive tends to increase. In previous studies, it was confirmed that older age, excessive 200 mg cumulative corticosteroid and treatment with Arbidol are associated with delayed COVID-19 RNA shedding 27,28. And our results suggest that COVID-19 patients with delayed virus shedding duration may have a higher risk of positive recurrence.…”

Association between glucocorticoids treatment and viral clearance delay in patients with COVID-19: a systematic review and meta-analysis

“…Of the 15,357 records, 38 studies [ 6 – 13 , 21 – 50 ] involving a total of 9572 patients were included in both qualitative and quantitative synthesis, and another study [ 51 ] was included only for qualitative synthesis (Fig. 1 ).…”