Clinical Characteristics and Factors Associated With Long-Term Viral Excretion in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: a Single-Center 28-Day Study
Abstract Background Despite the ongoing spread of coronavirus disease 2019 (COVID-19), knowledge about factors affecting prolonged viral excretion is limited. Methods In this study, we retrospectively collected data from 99 hospitalized patients with coronavirus disease 2019 (COVID-19) between 19 Ja...
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| Veröffentlicht in: | The Journal of infectious diseases 2020-08, Vol.222 (6), p.910-918 |
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| creator | Shi, Ding Wu, Wenrui Wang, Qing Xu, Kaijin Xie, Jiaojiao Wu, Jingjing Lv, Longxian Sheng, Jifang Guo, Jing Wang, Kaicen Fang, Daiqiong Li, Yating Li, Lanjuan |
| description | Abstract
Background
Despite the ongoing spread of coronavirus disease 2019 (COVID-19), knowledge about factors affecting prolonged viral excretion is limited.
Methods
In this study, we retrospectively collected data from 99 hospitalized patients with coronavirus disease 2019 (COVID-19) between 19 January and 17 February 2020 in Zhejiang Province, China. We classified them into 2 groups based on whether the virus test results eventually became negative. Cox proportional hazards regression was used to evaluate factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding.
Results
Among 99 patients, 61 patients had SARS-CoV-2 clearance (virus-negative group), but 38 patients had sustained positive results (virus-positive group). The median duration of SARS-CoV-2 excretion was 15 (interquartile range, 12–19) days among the virus-negative patients. The shedding time was significantly increased if the fecal SARS-CoV-2 RNA test result was positive. Male sex (hazard ratio [HR], 0.58 [95% confidence interval {CI}, .35–.98]), immunoglobulin use (HR, 0.42 [95% CI, .24–.76]), APACHE II score (HR, 0.89 [95% CI, .84–.96]), and lymphocyte count (HR, 1.81 [95% CI, 1.05–3.1]) were independent factors associated with a prolonged duration of SARS-CoV-2 shedding. Antiviral therapy and corticosteroid treatment were not independent factors.
Conclusions
SARS-CoV-2 RNA clearance time was associated with sex, disease severity, and lymphocyte function. The current antiviral protocol and low-to-moderate dosage of corticosteroid had little effect on the duration of viral excretion.
Male sex, immunoglobulin use, APACHE II score, and lymphocyte count were independent factors associated with the duration of SARS-CoV-2 RNA shedding. The current antiviral protocol and low-to-moderate dosage of corticosteroid had little effect on the duration of viral excretion. |
| doi_str_mv | 10.1093/infdis/jiaa388 |
| format | Article |
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Background
Despite the ongoing spread of coronavirus disease 2019 (COVID-19), knowledge about factors affecting prolonged viral excretion is limited.
Methods
In this study, we retrospectively collected data from 99 hospitalized patients with coronavirus disease 2019 (COVID-19) between 19 January and 17 February 2020 in Zhejiang Province, China. We classified them into 2 groups based on whether the virus test results eventually became negative. Cox proportional hazards regression was used to evaluate factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding.
Results
Among 99 patients, 61 patients had SARS-CoV-2 clearance (virus-negative group), but 38 patients had sustained positive results (virus-positive group). The median duration of SARS-CoV-2 excretion was 15 (interquartile range, 12–19) days among the virus-negative patients. The shedding time was significantly increased if the fecal SARS-CoV-2 RNA test result was positive. Male sex (hazard ratio [HR], 0.58 [95% confidence interval {CI}, .35–.98]), immunoglobulin use (HR, 0.42 [95% CI, .24–.76]), APACHE II score (HR, 0.89 [95% CI, .84–.96]), and lymphocyte count (HR, 1.81 [95% CI, 1.05–3.1]) were independent factors associated with a prolonged duration of SARS-CoV-2 shedding. Antiviral therapy and corticosteroid treatment were not independent factors.
Conclusions
SARS-CoV-2 RNA clearance time was associated with sex, disease severity, and lymphocyte function. The current antiviral protocol and low-to-moderate dosage of corticosteroid had little effect on the duration of viral excretion.
Male sex, immunoglobulin use, APACHE II score, and lymphocyte count were independent factors associated with the duration of SARS-CoV-2 RNA shedding. The current antiviral protocol and low-to-moderate dosage of corticosteroid had little effect on the duration of viral excretion.</description><identifier>ISSN: 0022-1899</identifier><identifier>EISSN: 1537-6613</identifier><identifier>DOI: 10.1093/infdis/jiaa388</identifier><identifier>PMID: 32614392</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Adrenal Cortex Hormones - therapeutic use ; Adult ; Antiviral agents ; Antiviral Agents - therapeutic use ; Antiviral drugs ; Betacoronavirus - isolation & purification ; Cell number ; China ; Coronaviridae ; Coronavirus Infections - drug therapy ; Coronavirus Infections - epidemiology ; Coronavirus Infections - virology ; Coronaviruses ; Corticosteroids ; COVID-19 ; Excretion ; Feces - virology ; Female ; Humans ; Lymphocytes ; Major and Brief Reports ; Male ; Middle Aged ; Pandemics ; Patients ; Pneumonia, Viral - drug therapy ; Pneumonia, Viral - epidemiology ; Pneumonia, Viral - virology ; Proportional Hazards Models ; Retrospective Studies ; Ribonucleic acid ; Risk Factors ; RNA ; RNA, Viral - isolation & purification ; SARS-CoV-2 ; Severe acute respiratory syndrome coronavirus 2 ; Severity of Illness Index ; Sex Factors ; Sex ratio ; Time Factors ; Virus Shedding</subject><ispartof>The Journal of infectious diseases, 2020-08, Vol.222 (6), p.910-918</ispartof><rights>The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c452t-b766f42cf1078c6728875305bab509bc4443aa07048a0093f12c17dd491f210a3</citedby><cites>FETCH-LOGICAL-c452t-b766f42cf1078c6728875305bab509bc4443aa07048a0093f12c17dd491f210a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32614392$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shi, Ding</creatorcontrib><creatorcontrib>Wu, Wenrui</creatorcontrib><creatorcontrib>Wang, Qing</creatorcontrib><creatorcontrib>Xu, Kaijin</creatorcontrib><creatorcontrib>Xie, Jiaojiao</creatorcontrib><creatorcontrib>Wu, Jingjing</creatorcontrib><creatorcontrib>Lv, Longxian</creatorcontrib><creatorcontrib>Sheng, Jifang</creatorcontrib><creatorcontrib>Guo, Jing</creatorcontrib><creatorcontrib>Wang, Kaicen</creatorcontrib><creatorcontrib>Fang, Daiqiong</creatorcontrib><creatorcontrib>Li, Yating</creatorcontrib><creatorcontrib>Li, Lanjuan</creatorcontrib><title>Clinical Characteristics and Factors Associated With Long-Term Viral Excretion in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: a Single-Center 28-Day Study</title><title>The Journal of infectious diseases</title><addtitle>J Infect Dis</addtitle><description>Abstract
Background
Despite the ongoing spread of coronavirus disease 2019 (COVID-19), knowledge about factors affecting prolonged viral excretion is limited.
Methods
In this study, we retrospectively collected data from 99 hospitalized patients with coronavirus disease 2019 (COVID-19) between 19 January and 17 February 2020 in Zhejiang Province, China. We classified them into 2 groups based on whether the virus test results eventually became negative. Cox proportional hazards regression was used to evaluate factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding.
Results
Among 99 patients, 61 patients had SARS-CoV-2 clearance (virus-negative group), but 38 patients had sustained positive results (virus-positive group). The median duration of SARS-CoV-2 excretion was 15 (interquartile range, 12–19) days among the virus-negative patients. The shedding time was significantly increased if the fecal SARS-CoV-2 RNA test result was positive. Male sex (hazard ratio [HR], 0.58 [95% confidence interval {CI}, .35–.98]), immunoglobulin use (HR, 0.42 [95% CI, .24–.76]), APACHE II score (HR, 0.89 [95% CI, .84–.96]), and lymphocyte count (HR, 1.81 [95% CI, 1.05–3.1]) were independent factors associated with a prolonged duration of SARS-CoV-2 shedding. Antiviral therapy and corticosteroid treatment were not independent factors.
Conclusions
SARS-CoV-2 RNA clearance time was associated with sex, disease severity, and lymphocyte function. The current antiviral protocol and low-to-moderate dosage of corticosteroid had little effect on the duration of viral excretion.
Male sex, immunoglobulin use, APACHE II score, and lymphocyte count were independent factors associated with the duration of SARS-CoV-2 RNA shedding. The current antiviral protocol and low-to-moderate dosage of corticosteroid had little effect on the duration of viral excretion.</description><subject>Adrenal Cortex Hormones - therapeutic use</subject><subject>Adult</subject><subject>Antiviral agents</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Antiviral drugs</subject><subject>Betacoronavirus - isolation & purification</subject><subject>Cell number</subject><subject>China</subject><subject>Coronaviridae</subject><subject>Coronavirus Infections - drug therapy</subject><subject>Coronavirus Infections - epidemiology</subject><subject>Coronavirus Infections - virology</subject><subject>Coronaviruses</subject><subject>Corticosteroids</subject><subject>COVID-19</subject><subject>Excretion</subject><subject>Feces - virology</subject><subject>Female</subject><subject>Humans</subject><subject>Lymphocytes</subject><subject>Major and Brief Reports</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pandemics</subject><subject>Patients</subject><subject>Pneumonia, Viral - drug therapy</subject><subject>Pneumonia, Viral - epidemiology</subject><subject>Pneumonia, Viral - virology</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Ribonucleic acid</subject><subject>Risk Factors</subject><subject>RNA</subject><subject>RNA, Viral - isolation & purification</subject><subject>SARS-CoV-2</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Severity of Illness Index</subject><subject>Sex Factors</subject><subject>Sex ratio</subject><subject>Time Factors</subject><subject>Virus Shedding</subject><issn>0022-1899</issn><issn>1537-6613</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc2O0zAUhS0EYsrAliWyxIpFZvyX2GGBVIUZGKkSiA6wjG4cp3XV2sV2KvpkvB6uUkawwhtL9jnfPfZB6CUlV5TU_Nq6obfxemMBuFKP0IyWXBZVRfljNCOEsYKqur5Az2LcEEIEr-RTdMFZRQWv2Qz9arbWWQ1b3KwhgE4m2Jisjhhcj2_zgQ8Rz2P02kIyPf5u0xovvFsV9ybs8Dcbsvfmpw4mWe-wdfgzJGtcipN0aQ4mGDzXYzL4i4n7bMjMI14eXR_8zuDGB-_gYMMYMcN3bjD6hHqLAS-tW21N0WScCZip4j1kYxr743P0ZIBtNC_O-yX6entz33wsFp8-3DXzRaFFyVLRyaoaBNMDJVLpSjKlZMlJ2UFXkrrTQggOQCQRCkj-z4EyTWXfi5oOjBLgl-jdxN2P3c70OifJD273we4gHFsPtv33xtl1u_KHVnIuFRcZ8PoMCP7HaGJqN34MLmdumZBc0bxOqqtJpYOPMZjhYQIl7anodiq6PRedDa_-zvUg_9NsFryZBH7c_w_2G-E1t40</recordid><startdate>20200817</startdate><enddate>20200817</enddate><creator>Shi, Ding</creator><creator>Wu, Wenrui</creator><creator>Wang, Qing</creator><creator>Xu, Kaijin</creator><creator>Xie, Jiaojiao</creator><creator>Wu, Jingjing</creator><creator>Lv, Longxian</creator><creator>Sheng, Jifang</creator><creator>Guo, Jing</creator><creator>Wang, Kaicen</creator><creator>Fang, Daiqiong</creator><creator>Li, Yating</creator><creator>Li, Lanjuan</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>5PM</scope></search><sort><creationdate>20200817</creationdate><title>Clinical Characteristics and Factors Associated With Long-Term Viral Excretion in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: a Single-Center 28-Day Study</title><author>Shi, Ding ; Wu, Wenrui ; Wang, Qing ; Xu, Kaijin ; Xie, Jiaojiao ; Wu, Jingjing ; Lv, Longxian ; Sheng, Jifang ; Guo, Jing ; Wang, Kaicen ; Fang, Daiqiong ; Li, Yating ; Li, Lanjuan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c452t-b766f42cf1078c6728875305bab509bc4443aa07048a0093f12c17dd491f210a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adrenal Cortex Hormones - therapeutic use</topic><topic>Adult</topic><topic>Antiviral agents</topic><topic>Antiviral Agents - therapeutic use</topic><topic>Antiviral drugs</topic><topic>Betacoronavirus - isolation & purification</topic><topic>Cell number</topic><topic>China</topic><topic>Coronaviridae</topic><topic>Coronavirus Infections - drug therapy</topic><topic>Coronavirus Infections - epidemiology</topic><topic>Coronavirus Infections - virology</topic><topic>Coronaviruses</topic><topic>Corticosteroids</topic><topic>COVID-19</topic><topic>Excretion</topic><topic>Feces - virology</topic><topic>Female</topic><topic>Humans</topic><topic>Lymphocytes</topic><topic>Major and Brief Reports</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pandemics</topic><topic>Patients</topic><topic>Pneumonia, Viral - drug therapy</topic><topic>Pneumonia, Viral - epidemiology</topic><topic>Pneumonia, Viral - virology</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Ribonucleic acid</topic><topic>Risk Factors</topic><topic>RNA</topic><topic>RNA, Viral - isolation & purification</topic><topic>SARS-CoV-2</topic><topic>Severe acute respiratory syndrome coronavirus 2</topic><topic>Severity of Illness Index</topic><topic>Sex Factors</topic><topic>Sex ratio</topic><topic>Time Factors</topic><topic>Virus Shedding</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shi, Ding</creatorcontrib><creatorcontrib>Wu, Wenrui</creatorcontrib><creatorcontrib>Wang, Qing</creatorcontrib><creatorcontrib>Xu, Kaijin</creatorcontrib><creatorcontrib>Xie, Jiaojiao</creatorcontrib><creatorcontrib>Wu, Jingjing</creatorcontrib><creatorcontrib>Lv, Longxian</creatorcontrib><creatorcontrib>Sheng, Jifang</creatorcontrib><creatorcontrib>Guo, Jing</creatorcontrib><creatorcontrib>Wang, Kaicen</creatorcontrib><creatorcontrib>Fang, Daiqiong</creatorcontrib><creatorcontrib>Li, Yating</creatorcontrib><creatorcontrib>Li, Lanjuan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shi, Ding</au><au>Wu, Wenrui</au><au>Wang, Qing</au><au>Xu, Kaijin</au><au>Xie, Jiaojiao</au><au>Wu, Jingjing</au><au>Lv, Longxian</au><au>Sheng, Jifang</au><au>Guo, Jing</au><au>Wang, Kaicen</au><au>Fang, Daiqiong</au><au>Li, Yating</au><au>Li, Lanjuan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical Characteristics and Factors Associated With Long-Term Viral Excretion in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: a Single-Center 28-Day Study</atitle><jtitle>The Journal of infectious diseases</jtitle><addtitle>J Infect Dis</addtitle><date>2020-08-17</date><risdate>2020</risdate><volume>222</volume><issue>6</issue><spage>910</spage><epage>918</epage><pages>910-918</pages><issn>0022-1899</issn><eissn>1537-6613</eissn><abstract>Abstract
Background
Despite the ongoing spread of coronavirus disease 2019 (COVID-19), knowledge about factors affecting prolonged viral excretion is limited.
Methods
In this study, we retrospectively collected data from 99 hospitalized patients with coronavirus disease 2019 (COVID-19) between 19 January and 17 February 2020 in Zhejiang Province, China. We classified them into 2 groups based on whether the virus test results eventually became negative. Cox proportional hazards regression was used to evaluate factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding.
Results
Among 99 patients, 61 patients had SARS-CoV-2 clearance (virus-negative group), but 38 patients had sustained positive results (virus-positive group). The median duration of SARS-CoV-2 excretion was 15 (interquartile range, 12–19) days among the virus-negative patients. The shedding time was significantly increased if the fecal SARS-CoV-2 RNA test result was positive. Male sex (hazard ratio [HR], 0.58 [95% confidence interval {CI}, .35–.98]), immunoglobulin use (HR, 0.42 [95% CI, .24–.76]), APACHE II score (HR, 0.89 [95% CI, .84–.96]), and lymphocyte count (HR, 1.81 [95% CI, 1.05–3.1]) were independent factors associated with a prolonged duration of SARS-CoV-2 shedding. Antiviral therapy and corticosteroid treatment were not independent factors.
Conclusions
SARS-CoV-2 RNA clearance time was associated with sex, disease severity, and lymphocyte function. The current antiviral protocol and low-to-moderate dosage of corticosteroid had little effect on the duration of viral excretion.
Male sex, immunoglobulin use, APACHE II score, and lymphocyte count were independent factors associated with the duration of SARS-CoV-2 RNA shedding. The current antiviral protocol and low-to-moderate dosage of corticosteroid had little effect on the duration of viral excretion.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>32614392</pmid><doi>10.1093/infdis/jiaa388</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | The Journal of infectious diseases, 2020-08, Vol.222 (6), p.910-918 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Adrenal Cortex Hormones - therapeutic use Adult Antiviral agents Antiviral Agents - therapeutic use Antiviral drugs Betacoronavirus - isolation & purification Cell number China Coronaviridae Coronavirus Infections - drug therapy Coronavirus Infections - epidemiology Coronavirus Infections - virology Coronaviruses Corticosteroids COVID-19 Excretion Feces - virology Female Humans Lymphocytes Major and Brief Reports Male Middle Aged Pandemics Patients Pneumonia, Viral - drug therapy Pneumonia, Viral - epidemiology Pneumonia, Viral - virology Proportional Hazards Models Retrospective Studies Ribonucleic acid Risk Factors RNA RNA, Viral - isolation & purification SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Severity of Illness Index Sex Factors Sex ratio Time Factors Virus Shedding |
| title | Clinical Characteristics and Factors Associated With Long-Term Viral Excretion in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: a Single-Center 28-Day Study |
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