Prevalence and Clinical Significance of Persistent Viral Shedding in Hospitalized Adult Patients with SARS-CoV-2 Infection: A Prospective Observational Study

doi:10.1007/s40121-020-00381-8

. 2021 Mar;10(1):387-398.

doi: 10.1007/s40121-020-00381-8. Epub 2021 Jan 8.

Prevalence and Clinical Significance of Persistent Viral Shedding in Hospitalized Adult Patients with SARS-CoV-2 Infection: A Prospective Observational Study

Antonio Vena¹, Lucia Taramasso¹, Antonio Di Biagio^{1

2}, Malgorzata Mikulska^{1

2}, Chiara Dentone¹, Andrea De Maria^{1

2}, Laura Magnasco¹, Laura Ambra Nicolini¹, Bianca Bruzzone³, Giancarlo Icardi^{2

3}, Andrea Orsi^{2

3}, Paolo Pelosi^{4

5

6}, Lorenzo Ball^{4

5

6}, Denise Battaglini^{5

6}, Iole Brunetti^{5

6}, Maurizio Loconte^{5

6}, Nicolò A Patroniti^{4

5

6}, Chiara Robba^{5

6}, Martina Bavastro¹, Matteo Cerchiaro¹, Daniele Roberto Giacobbe¹, Irene Schiavetti⁷, Marco Berruti^{1

2}, Matteo Bassetti^{8

9}; GECOVID study group

Collaborators, Affiliations

Collaborators

GECOVID study group:
Anna Alessandrini, Marco Camera, Emanuele Delfino, Andrea De Maria, Chiara Dentone, Antonio Di Biagio, Ferdinando Dodi, Antonio Ferrazin, Giovanni Mazzarello, Malgorzata Mikulska, Laura Nicolini, Federica Toscanini, Daniele Roberto Giacobbe, Antonio Vena, Lucia Taramasso, Elisa Balletto, Federica Portunato, Eva Schenone, Nirmala Rosseti, Federico Baldi, Marco Berruti, Federica Briano, Silvia Dettori, Laura Labate, Laura Magnasco, Michele Mirabella, Rachele Pincino, Chiara Russo, Giovanni Sarteschi, Chiara Sepulcri, Stefania Tutino, Roberto Pontremoli, Valentina Beccati, Salvatore Casciaro, Massimo Casu, Francesco Gavaudan, Maria Ghinatti, Elisa Gualco, Giovanna Leoncini, Paola Pitto, Kassem Salam

Affiliations

¹ Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy.
² Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
³ Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy.
⁴ Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
⁵ Anesthesia and Intensive Care, IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genoa, Italy.
⁶ Interventional Pulmonology Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy.
⁷ Section of Biostatistics, Department of Health Sciences, University of Genoa, Genoa, Italy.
⁸ Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy. matteo.bassetti@unige.it.
⁹ Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. matteo.bassetti@unige.it.

PMID: 33417230
PMCID: PMC7791162
DOI: 10.1007/s40121-020-00381-8

Prevalence and Clinical Significance of Persistent Viral Shedding in Hospitalized Adult Patients with SARS-CoV-2 Infection: A Prospective Observational Study

Antonio Vena et al. Infect Dis Ther. 2021 Mar.

. 2021 Mar;10(1):387-398.

doi: 10.1007/s40121-020-00381-8. Epub 2021 Jan 8.

Authors

Collaborators

GECOVID study group:
Anna Alessandrini, Marco Camera, Emanuele Delfino, Andrea De Maria, Chiara Dentone, Antonio Di Biagio, Ferdinando Dodi, Antonio Ferrazin, Giovanni Mazzarello, Malgorzata Mikulska, Laura Nicolini, Federica Toscanini, Daniele Roberto Giacobbe, Antonio Vena, Lucia Taramasso, Elisa Balletto, Federica Portunato, Eva Schenone, Nirmala Rosseti, Federico Baldi, Marco Berruti, Federica Briano, Silvia Dettori, Laura Labate, Laura Magnasco, Michele Mirabella, Rachele Pincino, Chiara Russo, Giovanni Sarteschi, Chiara Sepulcri, Stefania Tutino, Roberto Pontremoli, Valentina Beccati, Salvatore Casciaro, Massimo Casu, Francesco Gavaudan, Maria Ghinatti, Elisa Gualco, Giovanna Leoncini, Paola Pitto, Kassem Salam

Affiliations

¹ Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy.
² Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
³ Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy.
⁴ Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
⁵ Anesthesia and Intensive Care, IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genoa, Italy.
⁶ Interventional Pulmonology Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy.
⁷ Section of Biostatistics, Department of Health Sciences, University of Genoa, Genoa, Italy.
⁸ Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy. matteo.bassetti@unige.it.
⁹ Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. matteo.bassetti@unige.it.

PMID: 33417230
PMCID: PMC7791162
DOI: 10.1007/s40121-020-00381-8

Abstract

Background: The goal of this study was to investigate the prevalence and factors associated with persistent viral shedding (PVS) in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Methods: This was a prospective observational study including all consecutive adults hospitalized with SARS-CoV-2 infection. When the first nasopharyngeal swab was positive for SARS-CoV-2 RNA (day 0), additional samples were obtained on days + 3, + 5, + 7 and then once every 7 days until virus detection was negative. PVS was defined as the duration of shedding of at least 21 days after diagnosis. The primary endpoint of this study was the prevalence of PVS.

Results: Data were obtained regarding 121 consecutive hospitalized patients with SARS-CoV-2 infection (median age 66 years, male sex 65.3%). Overall, the prevalence of PVS was 38% (46/121 patients). According to univariate analysis, factors associated with PVS were immunosuppression (6.7% vs 21.7%, p = 0.02), increased interleukin-6 (IL-6) levels (≥ 35 ng/ml) at the time of diagnosis (43.4% vs 67.3%, p = 0.02), time from onset of symptoms to diagnosis (median days 7.0 vs 3.5, p = 0.001), intensive care unit admission (22.7% vs 43.5%, p = 0.02), and need for invasive mechanical ventilation (20.0% vs 41.3%, p = 0.01). The multivariate analysis indicated that immunosuppression, increased IL-6 levels at the time of diagnosis, time from onset of symptoms to diagnosis, and need for mechanical ventilation were independent factors associated with PVS.

Conclusions: PVS was detected in up to 38% of hospitalized patients with SARS-CoV-2 infection and was strongly associated with immunosuppression, increased IL-6 levels, and the need for mechanical ventilation.

Keywords: COVID-19; IL-6; Outcome; SARS-CoV-2; Viral shedding.

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Figures

**Fig. 1**
Flow diagram of hospitalized patients with confirmed SARS-CoV-2 infection included in this study

**Fig. 2**
Cumulative frequency of patients with positive SARS-Cov-2 RNA at different time points (percentage)

See this image and copyright information in PMC

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References

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[1] Bassetti M, Vena A, Giacobbe DR. The novel Chinese coronavirus (2019-nCoV) infections: challenges for fighting the storm. Eur J Clin Invest. 2020;50(3):e13209. doi: 10.1111/eci.13209. - DOI - PMC - PubMed

[2] Bassetti M, Vena A, Giacobbe DR. The novel Chinese coronavirus (2019-nCoV) infections: challenges for fighting the storm. Eur J Clin Invest. 2020;50(3):e13209. doi: 10.1111/eci.13209. - DOI - PMC - PubMed

[3] Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–733. doi: 10.1056/NEJMoa2001017. - DOI - PMC - PubMed

[4] Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–733. doi: 10.1056/NEJMoa2001017. - DOI - PMC - PubMed

[5] Vena A, Berruti M, Adessi A, et al. Prevalence of antibodies to SARS-CoV-2 in Italian adults and associated risk factors. J Clin Med. 2020;9(9):2780. - PMC - PubMed

[6] Vena A, Berruti M, Adessi A, et al. Prevalence of antibodies to SARS-CoV-2 in Italian adults and associated risk factors. J Clin Med. 2020;9(9):2780. - PMC - PubMed

[7] Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5. - DOI - PMC - PubMed

[8] Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5. - DOI - PMC - PubMed

[9] Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–9. - PMC - PubMed

[10] Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–9. - PMC - PubMed

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Prevalence and Clinical Significance of Persistent Viral Shedding in Hospitalized Adult Patients with SARS-CoV-2 Infection: A Prospective Observational Study

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Prevalence and Clinical Significance of Persistent Viral Shedding in Hospitalized Adult Patients with SARS-CoV-2 Infection: A Prospective Observational Study

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