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. 2020 Sep:98:252-260.
doi: 10.1016/j.ijid.2020.06.091. Epub 2020 Jun 30.

Associations of clinical characteristics and treatment regimens with the duration of viral RNA shedding in patients with COVID-19

Xudan Chen  1 , Baoyi Zhu  2 , Wenxin Hong  1 , Jianwen Zeng  2 , Xi He  1 , Jingfeng Chen  1 , Haipeng Zheng  1 , Shuang Qiu  1 , Ying Deng  3 , Juliana C N Chan  4 , Jian Wang  5 , Yuying Zhang  6
Affiliations

Associations of clinical characteristics and treatment regimens with the duration of viral RNA shedding in patients with COVID-19

Xudan Chen et al. Int J Infect Dis. 2020 Sep.

Abstract

Objective: The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic, but the factors influencing viral RNA shedding, which would help inform optimal control strategies, remain unclear.

Methods: The clinical course and viral RNA shedding pattern of 267 consecutive symptomatic COVID-19 patients admitted to the hospital from January 20, 2020 to March 15, 2020 were evaluated retrospectively.

Results: The median duration of viral RNA shedding was 12 days (interquartile range 8-16 days) after the onset of illness. Of the 267 patients included in this study, 65.2% had viral RNA clearance within 14 days, 88.8% within 21 days, and 94.4% within 28 days. Older age (hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.98-1.00; p = 0.04), time lag from illness onset to hospital admission (HR 0.91, 95% CI 0.88-0.94; p < 0.001), diarrhea (HR 0.59, 95% CI 0.36-0.96; p = 0.036), corticosteroid treatment (HR 0.60, 95% CI 0.39-0.94; p = 0.024), and lopinavir/ritonavir use (HR 0.70, 95% CI 0.52-0.94; p = 0.014) were significantly and independently associated with prolonged viral RNA shedding.

Conclusions: Early detection and timely hospital admission may be warranted for symptomatic COVID-19 patients, especially for older patients and patients with diarrhea. Corticosteroid treatment is associated with prolonged viral RNA shedding and should be used with caution. Lopinavir/ritonavir use may be associated with prolonged viral RNA shedding in non-severe patients; further randomized controlled trials are needed to confirm this finding.

Keywords: COVID-19; Corticosteroid; Diarrhea; Lopinavir/ritonavir; Risk factors; Viral RNA shedding.

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Figures

Figure 1
Figure 1
Flow diagram of patients with confirmed COVID-19 included in the study and their clinical outcomes. *One 81-year-old woman died 17 days after hospital admission. She had serious illness and comorbid pancreatic cancer, diabetes, and cardiovascular disease at the time of admission.
Figure 2
Figure 2
Cumulative viral RNA clearance rate by severity of COVID-19. The diagram shows the cumulative clearance rate within 7 days, 14 days, 21 days, 28 days, 35 days, and 42 days. The number (%) of patients is presented.
See this image and copyright information in PMC

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