Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb;93(2):794-802.
doi: 10.1002/jmv.26307. Epub 2020 Jul 27.

Association between detectable SARS-COV-2 RNA in anal swabs and disease severity in patients with coronavirus disease 2019

Weiyin Lin  1 , Zhiwei Xie  2 , Yueping Li  2 , Liya Li  3 , Chunyan Wen  1 , Yi Cao  1 , Xiaoting Chen  1 , Xu Ou  1 , Fengyu Hu  3 , Feng Li  3 , Xiaoping Tang  3 , Weiping Cai  1 , Linghua Li  1
Affiliations

Association between detectable SARS-COV-2 RNA in anal swabs and disease severity in patients with coronavirus disease 2019

Weiyin Lin et al. J Med Virol. 2021 Feb.

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was found in the intestines and feces, but its clinical significance is not completely clear. We aim to characterize the longitudinal test results of SARS-CoV-2 RNA in anal swabs and to explore the association with disease severity.

Methods: We included laboratory-confirmed coronavirus disease 2019 (COVID-19) patients, who were hospitalized in Guangzhou Eighth People's Hospital and excluded those who had not received anal swabs for SARS-COV-2 RNA testing. Epidemiological, clinical, and laboratory data were obtained. Throat swabs and anal swabs were collected periodically for SARS-COV-2 RNA detection.

Results: Two hundred and seventeen eligible patients (median aged 50 years, 50.2% were females) were analyzed. 21.2% (46/217) of the patients were detected with SARS-CoV-2 RNA in anal swabs. The duration of viral RNA was longer, but the viral load was lower in anal swabs than throat swabs in the early stage of the disease. During a median follow-up of 20 days, 30 (13.8%) patients were admitted to the intensive care unit (ICU) for high-flow nasal cannula or higher-level oxygen support measures to correct hypoxemia. Detectable viral RNA in anal swabs (adjusted hazard ratio [aHR], 2.50; 95% confidence interval [CI], 1.20-5.24), increased C-reactive protein (aHR, 3.14; 95% CI, 1.35-7.32) and lymphocytopenia (aHR, 3.12; 95% CI, 1.46-6.67) were independently associated with ICU admission. The cumulative incidence of ICU admission was higher among patients with detectable viral RNA in anal swabs (26.3% vs 10.7%, P = .006).

Conclusion: Detectable SARS-CoV-2 RNA in the digestive tract was a potential warning indicator of severe disease.

Keywords: COVID-19; SARS-CoV-2 RNA; anal swab; disease severity.

PubMed Disclaimer

Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Longitudinal results of anal swabs and throat swabs among the 46 patients with detectable SARS‐CoV‐2 RNA in the anal swab
Figure 2
Figure 2
Cumulative incidence of intensive care unit (ICU) admission in patients with detectable and undetectable SARS‐CoV‐2 RNA in the anal swab
Figure 3
Figure 3
Comparision of longitudinal cycle threshold (C t) values between anal swabs (AS) and throat swabs (TS). A, C t values of the open reading frame 1ab (ORF1ab) genes. B, C t values of the nucleocapsid protein (N) genes
See this image and copyright information in PMC

References

    1. WHO. World Health Organization coronavirus disease 2019 (COVID‐19) situation report‐152. https://www.who.int/docs/default-source/coronaviruse/situation-reports/2.... Accessed June 20, 2020.
    1. Wu F, Zhao S, Yu B, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579:265‐269. - PMC - PubMed
    1. Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579:270‐273. - PMC - PubMed
    1. Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395:565‐574. - PMC - PubMed
    1. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708‐1720. - PMC - PubMed

Publication types

MeSH terms