Clinical course and risk factors for recurrence of positive SARS-CoV-2 RNA: a retrospective cohort study from Wuhan, China

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The objective of this study was to determine the clinical course and risk factors for patients showing recurrent SARS-CoV-2 RNA positivity. A total of 1087 COVID-19 patients confirmed by RT-PCR from February 24, 2020 to March 31, 2020 were retrospectively enrolled. Advanced age was significantly associated with mortality. In addition, 81 (7.6%) of the discharged patients tested positive for SARS-CoV-2 RNA during the isolation period. For patients with recurrent RT-PCR positivity, the median duration from illness onset to recurrence was 50 days. Multivariate regression analysis identified elevated serum IL-6, increased lymphocyte counts and CT imaging features of lung consolidation during hospitalization as the independent risk factors of recurrence. We hypothesized that the balance between immune response and virus toxicity may be the underlying mechanism of this phenomenon. For patients with a high risk of recurrence, a prolonged observation and additional preventative measures should be implemented for at least 50 days after illness onset to prevent future outbreaks.

Keywords: COVID-19; SARS-CoV-2; clinical course; coronavirus disease 2019; recurrence; risk factor.

Figure 1

Individual duration of viral shedding and positive SARS-CoV-2 RNA recurrence from illness onset after discharge. The timing and results of RT-PCR examinations for SARS-CoV-2 RNA in details. SARS-CoV-2=severe acute respiratory syndrome coronavirus 2. RT-PCR=reverse transcription-polymerase chain reaction.

Figure 2

The median duration of different stages in patients with recurrence of positive SARS-CoV-2 RNA after discharge. (A) The median duration from illness onset to initial RT-PCR confirmation, onset of complete RNA negative status and recurrent RT-PCR positivity after discharge, and from discharge to recurrence. (B) The median duration from initial RT-PCR confirmation to onset of complete RNA negative status and recurrent RT-PCR positivity after discharge, and from onset of complete RNA negative status to recurrence. SARS-CoV-2=severe acute respiratory syndrome coronavirus 2. RT-PCR=reverse transcription-polymerase chain reaction.