Proinflammatory cytokines are associated with prolonged viral RNA shedding in COVID-19 patients

Gao, Chun; Zhu, Li; Jin, Cheng; Tong, Yi Xin; Xiao, Ai Tang; Zhang, Sheng

doi:10.1016/j.clim.2020.108611

Cited by 17 publications

(19 citation statements)

References 23 publications

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“…Our previous study also revealed distinct characteristics between patients with or without prolonged viral RNA shedding. We found that hypertension, older age, lymphopenia and high levels of interleukin-2 receptor were independent risk factors for prolonged viral RNA shedding [15]. Patients with prolonged RNA shedding were generally asymptomatic.…”

Section: Discussionmentioning

confidence: 75%

“…We found that hypertension, older age, lymphopenia and high levels of interleukin (IL)-2R were independent risk factors for prolonged viral RNA shedding. [ 15 ] Patients with prolonged RNA shedding were generally asymptomatic. However, a recent study reported a case of recurrent symptomatic pneumonia with rebound positive RT-PCR test after discharge from hospital.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and impact factors of recurrent positive SARS-CoV-2 detection in 599 hospitalized COVID-19 patients

Gao

Zhu

Jin

et al. 2021

Clinical Microbiology and Infection

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Objectives Re-positive tests for SARS-CoV-2 in Coronavirus Disease 2019 (COVID-19) patients were common. We aimed to investigate the rate and risk factors of recurrent positive detection of SARS-CoV-2 in hospitalized COVID-19 patients. Methods Oropharyngeal and nasopharyngeal swabs (n=3513) were collected to detect SARS-CoV-2 during the hospitalization. We analyzed the recurrent positive rate after consecutive negative results and its relationship to demographic characteristics. Results Among 599 enrolled COVID-19 patients, the median time for viral RNA shedding was 24 days (IQR, 19-33 days). The positive rate of RT-PCR was 35.9% (215/599), 17.0% (65/383) and 12.4% (23/185) after one, two and three consecutive negative RT-PCR test results respectively. Medians of CT-values of initial positive test, rebound positive after two consecutive negative results, and rebound positive after three consecutive negative results were 28.8, 32.8 and 36.1 respectively. Compare with male patients, females had a significant higher rate of recurrent positive RT-PCR after three consecutive negative results (18.2%, 18/99 vs. 5.8%, 5/86, p=0.013). Older age (≥55 yrs) had a significant higher rate of recurrent positive RT-PCR after one negative result (42.3%, 165/390, vs. 23.9%, 50/209, p<0.001). Nasopharyngeal swab tests produced a higher positive rate than oropharyngeal swab tests (37.3%, 152/408 vs. 35.8%, 1111/3105). Conclusions Our study revealed the prevalence and dynamic characteristics of recurrent positive RT-PCR to SARS-CoV-2. We showed that around 17.0% (65/383) patients were tested positive for SARS-CoV-2 after two consecutive negative results. Patients with rebound positive RT-PCR test had a low viral load. Older age and female were risk factors for recurrent positive results.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Prevalence and impact factors of recurrent positive SARS-CoV-2 detection in 599 hospitalized COVID-19 patients

Gao

Zhu

Jin

et al. 2021

Clinical Microbiology and Infection

Self Cite

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“…Three studies were prospective ( 24 , 30 , 36 ),14 were retrospective ( 22 , 23 , 25 – 29 , 31 , 33 , 34 , 37 – 40 ), whereas the remaining two did not explicitly state the study design ( 32 , 35 ). Disease severity, based on current clinical guidelines, was assessed in 11 studies ( 22 , 23 , 25 , 28 , 30 , 33 , 35 , 37 – 40 ), prolonged viral clearance in two ( 26 , 36 ), transfer to ICU in one ( 29 ), survival in three ( 27 , 31 , 32 ), presence of acute respiratory distress syndrome in one ( 34 ), and multiple end points in one ( 24 ).…”

Section: Resultsmentioning

confidence: 99%

“…After a full-text review of the remaining 20 articles, one study was further excluded because of missing data, leaving 19 studies for analysis (22-40). The characteristics of these studies, all conducted in China, are described in (26,36), transfer to ICU in one (29), survival in three (27,31,32), presence of acute respiratory distress syndrome in one (34), and multiple end points in one (24).…”

Section: Literature Search and Study Selectionmentioning

confidence: 99%

Serum Prealbumin Concentrations, COVID-19 Severity, and Mortality: A Systematic Review and Meta-Analysis

Zinellu

Mangoni

2021

Front. Med.

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Excessive inflammation and malnutrition are associated with coronavirus disease 2019 (COVID-19) severity and mortality. Combined biomarkers of malnutrition and inflammation, such as serum prealbumin, might be particularly attractive for early risk stratification. We conducted a systematic review and meta-analysis of studies reporting serum prealbumin in patients with COVID-19. We searched PubMed, Web of Science and Scopus, between January and November 2020, for studies reporting data on serum prealbumin, COVID-19 severity, defined as severe illness, prolonged viral load, receiving mechanical ventilation or admitted to intensive care unit (ICU), and mortality. Nineteen studies in 4,616 COVID-19 patients were included in the meta-analysis. Pooled results showed that serum prealbumin concentrations were significantly lower in patients with severe disease and non-survivors (standard mean difference, SMD, −0.92, 95% CI, −1.10 to −0.74, P < 0.001). Extreme heterogeneity was observed (I2 = 77.9%; P < 0.001). In sensitivity analysis, the effect size was not significantly affected when each study was in turn removed (range between −0.86 and −0.95). The Begg's (P = 0.06) and Egger's t-tests (P = 0.26) did not show publication bias. Pooled SMD values were significantly and negatively associated with age (t = −2.18, P = 0.045) and C-reactive protein (t = −3.85, P = 0.002). In our meta-analysis, lower serum prealbumin concentrations were significantly associated with COVID-19 severity and mortality. This combined marker of malnutrition and inflammation might assist with early risk stratification and management in this group.

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“…There are two explanations for why immunocompromised individuals continuously test positive via PCR: either they are shedding residual RNA or shedding the infectious replication-competent virus. 6 It is thought that immunosuppression with persistent viral shedding may be a protective factor because of the reduced immune response. The use of Rituximab, a monoclonal antibody, dampens the seroconversion immune response.…”

Section: Discussionmentioning

confidence: 99%

Longest reported case of symptomatic COVID-19 reporting positive for over 230 days in an immunocompromised patient in the United States

Chaudhry

Didenko²,

Chaudhry

et al. 2021

SAGE Open Medical Case Reports

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Coronavirus 2019 (COVID-19) pneumonia was first noted in Wuhan, China. Since the start of the pandemic, there have been millions of cases diagnosed. The average time from onset of symptoms to testing negative SARS-CoV-2 via reverse transcription polymerase chain reaction is roughly 25 days. In patients who continually test positive for COVID-19, it is essential to determine precisely which risk factors contribute to the increase in viral shedding duration. We present a case about a 62-year-old man who has persistently tested positive for COVID-19 for more than 230 days. We followed his treatment course, in which he had been hospitalized multiple times since the onset of symptoms back in April 2020. We have determined that patients with immunosuppression, especially those taking corticosteroids, are at increased risk of prolonged viral shedding. It is essential to continually monitor these immunocompromised patients as they required a greater time period in order to have an appropriate immune response in which antibodies are created.

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Proinflammatory cytokines are associated with prolonged viral RNA shedding in COVID-19 patients

Cited by 17 publications

References 23 publications

Prevalence and impact factors of recurrent positive SARS-CoV-2 detection in 599 hospitalized COVID-19 patients

Prevalence and impact factors of recurrent positive SARS-CoV-2 detection in 599 hospitalized COVID-19 patients

Serum Prealbumin Concentrations, COVID-19 Severity, and Mortality: A Systematic Review and Meta-Analysis

Longest reported case of symptomatic COVID-19 reporting positive for over 230 days in an immunocompromised patient in the United States

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