Risk factors for viral RNA shedding in COVID-19 patients

Fu, Yu; Han, Ping; Zhu, Rui; Bai, Tao; Yi, Jianhua; Zhao, Xi; Tao, Meihui; Quan, Runze; Chen, Chaoyue; Zhang, Ying; He, Qin; Jing, Mengjia; Xiong, Xiaofeng; Tian, Dean; Yan, Wei

doi:10.1183/13993003.01190-2020

Cited by 72 publications

(85 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On multivariate analysis, old age, malignancy, steroid use, and concomitant pneumonia were identified as risk factors for prolonged viral shedding in this study, consistent with previous studies ( Fu et al, 2020 , Yan et al, 2020a , Yan et al, 2020b , Zhou et al, 2020 ). Old age, comorbidities, and steroid use might blunt the host immune response, thereby promoting viral replication.…”

Section: Discussionsupporting

confidence: 91%

“…When analyzing the effect of antiviral agents, the timing of antiviral therapy is an important issue to be considered. Early (within 7 days from symptom onset) initiation of antiviral therapy may be critical in reducing SARS-CoV-2 viral load, as previously noted ( Fu et al, 2020 , Keyaerts et al, 2004 , Yan et al, 2020a , Yan et al, 2020b ). Due to the limitation of our database, it was difficult to know the initiation timing of antiviral treatment in each individual patient; however, the government of South Korea had launched a series of aggressive measures to perform tight contact tracing and mass screening tests, which enabled early diagnosis within 3–5 days from symptom onset ( Ryu et al, 2020 ).…”

Section: Discussionmentioning

confidence: 58%

“…Recent studies suggested that the negative outcomes in patients with underlying cerebrovascular disease might be due to elevated expression of ACE2 ( Choi et al, 2020a ). Besides prolonged viral shedding, pre-existing cardiovascular diseases were associated with worse outcomes of COVID-19 ( Fu et al, 2020 ). Although unclear, COVID-19 might trigger acute coronary syndrome, arrhythmia, or acute exacerbation of heart failure, similar to influenza viral infection ( Madjid et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of antiviral effect for mild-to-moderate COVID-19 cases between lopinavir/ritonavir versus hydroxychloroquine: A nationwide propensity score-matched cohort study

Choi

Kang

Shin

et al. 2021

International Journal of Infectious Diseases

View full text Add to dashboard Cite

Highlights We compared the antiviral effect of LPV/r and HCQ in patients with mild-to-moderate COVID-19 using a large sample size health insurance database. SARS-CoV-2 viral shedding duration was similar between HCQ and LPV/r groups. Neither HCQ nor LPV/r monotherapy showed any benefit in improving viral clearance compared with the control group.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of antiviral effect for mild-to-moderate COVID-19 cases between lopinavir/ritonavir versus hydroxychloroquine: A nationwide propensity score-matched cohort study

Choi

Kang

Shin

et al. 2021

International Journal of Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…The ECDC recommends two consecutive negative RT-PCR tests from respiratory specimens at 24 h interval at least 8 days after symptoms onset to discontinue isolation precautions in hospitalized COVID-19 patients [10]. Similar recommendations were issued by several institutions in other continents [5,19]. Specimens were usually collected in the upper respiratory tract, and data on lower respiratory samples are rarely considered.…”

Section: Discussionmentioning

confidence: 99%

Diabetes mellitus is a risk factor for prolonged SARS-CoV-2 viral shedding in lower respiratory tract samples of critically ill patients

et al. 2020

View full text Add to dashboard Cite

Purpose The length of time a critically ill coronavirus disease 2019 (COVID-19) patient remains infectious and should therefore be isolated remains unknown. This prospective study was undertaken in critically ill patients to evaluate the reliability of single negative real-time polymerase chain reaction (RT-PCR) in lower tracheal aspirates (LTA) in predicting a second negative test and to analyze clinical factors potentially influencing the viral shedding. Methods From April 9, 2020 onwards, intubated COVID-19 patients treated in the intensive care unit were systematically evaluated for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by RT-PCR of nasopharyngeal swabs and LTA. The time to negativity was defined as the time between the onset of symptoms and the viral clearance in LTA. In order to identify risk factors for prolonged viral shedding, we used univariate and multivariate Cox proportional hazards models. Results Forty-eight intubated SARS-CoV-2 patients were enrolled. Overall, we observed that the association of the first negative RT-PCR with a second negative result was 96.7%. Median viral shedding was 25 (IQR: 21.5-28) days since symptoms' onset. In the univariate Cox model analysis, type 2 diabetes mellitus was associated with a prolonged viral RNA shedding (hazard ratio [HR]: 0.41, 95% CI: 0.06-3.11, p = 0.04). In the multivariate Cox model analysis, type 2 diabetes was associated with a prolonged viral RNA shedding (HR: 0.31, 95% CI: 0.11-0.89, p = 0.029). Conclusion Intubated patients with type 2 diabetes mellitus may have prolonged SARS-CoV-2 shedding. In critically ill COVID-19 patients, one negative LTA should be sufficient to assess and exclude infectivity.

show abstract

“…Viral RNA has been shown to be detectable in recovered patients, although the duration of viral RNA shedding reported varied among infected patients. Viral RNA shedding can last at least 6 weeks [12][13][14][15][16]. Liu et al reported that patients with severe symptoms had a higher viral load and a longer viral shedding period than patients with mild symptoms (<10 days for the group with mild symptoms and >10 days for the group with severe symptoms).…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 RNA shedding in recovered COVID-19 cases and the presence of antibodies against SARS-CoV-2 in recovered COVID-19 cases and close contacts

Chirathaworn

Sripramote

Chalongviriyalert

et al. 2020

Preprint

View full text Add to dashboard Cite

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 emerged in December 2019 and has spread globally. Although Thailand has been effective at controlling the spread of COVID-19, disease surveillance and information on antibody responses in infected cases and close contacts are needed because there is still no specific treatment or vaccine available. We investigated 217 recovered COVID-19 cases to monitor their viral RNA shedding and production of antibodies against SARS-CoV-2. The presence of antibodies in blood samples from 308 close contacts of COVID-19 cases was also determined. Viral RNA was still detectable in 6.6 % of recovered COVID-19 cases. The most prolonged duration of viral RNA shedding detected in this study was 105 days. IgM, IgG, and IgA antibodies against SARS-CoV-2 were detected in 13.82, 88.48, and 83.41 % of the recovered cases 4–12 weeks after disease onset, respectively. Although the patients had recovered from their illness, the levels of antibodies detected showed association with their symptoms during their stay in hospital. Fifteen of the 308 contacts (4.87 %) of COVID-19 cases tested positive for IgG antibodies. The presence of antibodies against SARS-CoV-2 suggested that there was viral exposure among close contacts. Viral clearance and the pattern of antibody responses in infected individuals are both crucial for effectively combatting SARS-CoV-2. Our study provides additional information on the natural history of this newly emerging disease related to both natural host defenses and a strategy for vaccine development.

show abstract

Risk factors for viral RNA shedding in COVID-19 patients

Abstract: Take home message: The median time from symptoms onset to viral RNA shedding was 19 days. Patients with CHD comorbidity or decreased albumin levels experienced delays in clearance of SARS-CoV-2 RNA.

Cited by 72 publications

References 7 publications

Comparison of antiviral effect for mild-to-moderate COVID-19 cases between lopinavir/ritonavir versus hydroxychloroquine: A nationwide propensity score-matched cohort study

Comparison of antiviral effect for mild-to-moderate COVID-19 cases between lopinavir/ritonavir versus hydroxychloroquine: A nationwide propensity score-matched cohort study

Diabetes mellitus is a risk factor for prolonged SARS-CoV-2 viral shedding in lower respiratory tract samples of critically ill patients

SARS-CoV-2 RNA shedding in recovered COVID-19 cases and the presence of antibodies against SARS-CoV-2 in recovered COVID-19 cases and close contacts

Contact Info

Product

Resources

About