Factors Associated With Prolonged Viral RNA Shedding in Patients with Coronavirus Disease 2019 (COVID-19)

Abstract

Background. An outbreak of coronavirus disease 2019 is becoming a public health emergency. Data are limited on the duration and host factors related to viral shedding.Methods. In this retrospective study, risk factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding were evaluated in a cohort of 113 symptomatic patients from 2 hospitals outside Wuhan.Results. The median (interquartile range) duration of SARS-CoV-2 RNA detection was 17 (13-22) days as measured from illness onset. When comparing patients with early (<15 days) and late (≥15 days after illness onset) viral RNA clearance, prolonged SARS-CoV-2 RNA shedding was associated with male sex (P = .009), old age (P = .033), concomitant hypertension (P = .009), delayed admission to hospital after illness onset (P = .001), severe illness at admission (P = .049), invasive mechanical ventilation (P = .006), and corticosteroid treatment (P = .025). Patients with longer SARS-CoV-2 RNA shedding duration had slower recovery of body temperature (P < .001) and focal absorption on radiograph images (P < .001) than patients with early SARS-CoV-2 RNA clearance. Male sex (OR, 3.24; 95% CI, 1.31-8.02), delayed hospital admission (OR, 1.30; 95% CI, 1.10-1.54), and invasive mechanical ventilation (OR, 9.88; 95% CI,.02) were independent risk factors for prolonged SARS-CoV-2 RNA shedding.Conclusions. Male sex, delayed admission to hospital after illness onset, and invasive mechanical ventilation were associated with prolonged SARS-CoV-2 RNA shedding. Hospital admission and general treatments should be started as soon as possible in symptomatic COVID-19 patients, especially male patients.

Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis

“…Our search for COVID-19, SARS and MERS identified 5120 citations. After removing duplicates, screening titles and abstracts, and reviewing full texts, we ultimately included 1 cohort study 8 including 84 patients with COVID-19 and ARDS, 5 cohort studies [19][20][21][22][23] including 679 patients with COVID-19 but without ARDS, 3 studies (2 cohort studies 24,25 and 1 RCT 26 ) including 7087 patients with SARS, and 2 cohort studies 27,28 including 623 patients with MERS.…”

“…One cohort study 20 reported an increase in the composite outcome of mortality or ICU admission with steroid use. Two cohort studies 21,22 suggested that corticosteroids use was associated with prolonged viral shedding (very low-quality evidence).…”

Case Report: Viral Shedding for 60 Days in a Woman with COVID-19

“…1 Novel coronavirus disease (COVID-19) has spread to more than 200 countries, and the death toll remains very high. 2 According to some retrospective analyses, the median duration of viral shedding was 12-20 days from illness onset, [3][4][5] whereas the longest duration recorded has been 49 days. 6 We present a case of COVID-19 with viral shedding for 60 days from the onset of symptoms.…”

Corticosteroid use in COVID-19 patients: A systematic review and meta-analysis on clinical outcomes

“…[33] Methylprednisolone was the most frequently used corticosteroid (13/22 studies). [33,[37][38][39][40][42][43][44]46,[48][49][50][51] In two studies methylprednisolone, hydrocortisone, or dexamethasone was used. [36,41] Ling et al used prednisolone or dexamethasone, [52] and Horby et al reported on dexamethasone use.…”

“…In four of these, mortality was only described in the overall study population and not speci ed for steroid or non-steroid study groups. [41,51,54,55] Two studies reported that corticosteroid treatment did not signi cantly affect mortality, without the possibility to quantify the effect. [42,43] In the remaining eight studies, the risk of corticosteroid use was quanti ed, and these were included to calculate the pooled estimate.…”