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Review
. 2022 Jun 1;42(1):16.
doi: 10.1186/s41232-022-00205-x.

Duration of SARS-CoV-2 RNA positivity from various specimens and clinical characteristics in patients with COVID-19: a systematic review and meta-analysis

Yasutaka Okita  1 , Takayoshi Morita  2 , Atsushi Kumanogoh  1   3   4   5
Affiliations
Review

Duration of SARS-CoV-2 RNA positivity from various specimens and clinical characteristics in patients with COVID-19: a systematic review and meta-analysis

Yasutaka Okita et al. Inflamm Regen. .

Abstract

Background: The duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA positivity will be important to prevent the spread of coronavirus disease 2019 (COVID-19). A systematic review and meta-analysis were conducted following PRISMA to determine the duration from several parts of the body and clinical characteristics affecting it.

Main text: PubMed, Web of Science, Scopus, and CENTRAL were searched for original studies reporting the duration from COVID-19 onset to the disappearance of viral RNA. Of the 1682 studies identified, 100 met the selection criteria and 13,431 patients were included in this study. The duration of SARS-CoV-2 RNA positivity was 18.29 [95% confidence interval: 17.00-19.89] days in the upper respiratory tract samples, 23.79 [20.43-27.16] days in the sputum, 14.60 [12.16-17.05] days in the blood, and 22.38 [18.40-26.35] days in the stool. Sensitivity analysis revealed that the duration was positively correlated with age, comorbidities, severity, and usage of glucocorticoid. Subgroup analysis indicated that the presence or absence of complications had the greatest impact on the difference in DSRP.

Conclusions: The duration of SARS-CoV-2 RNA positivity was 18.29 days in the upper respiratory tract samples. The duration in the sputum and the stool was longer, while that in the blood was shorter. The duration in the upper respiratory tract samples was longer in older, with any comorbidities, severer, and treated with glucocorticoid. These results provide the basic data for the duration of SARS-CoV-2 RNA positivity, and in the future, the effect of vaccination against SARS-CoV-2 and the SARS-CoV-2 variants on the duration of RNA positivity should be assessed.

Keywords: COVID-19; Coronavirus; Meta-analysis; SARS-CoV-2; SARS-CoV-2 RNA positivity; Systematic review; Viral shedding.

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Conflict of interest statement

All authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
The funnel plots of the duration of SARS-CoV-2 RNA positivity in various samples. The funnel plots of the duration of SARS-CoV-2 RNA positivity in the upper respiratory tract samples (a), the sputum (b), the blood (c), and the stool (d) were shown
Fig. 3
Fig. 3
Forest plot: a meta-analysis of the duration of SARS-CoV-2 RNA positivity in the respiratory tract samples. The duration of SARS-CoV-2 RNA positivity from the onset of COVID-19 in the upper respiratory tract samples (a) and the sputum (b) was calculated using the random effects model. The difference in the duration of SARS-CoV-2 RNA positivity between the sputum and the upper respiratory samples was calculated using the random effects model (c). Experimental meant the sputum and control meant the upper respiratory tract samples. MRAW, the raw data of mean; 95%-CI, 95% confidence interval; SD, standard deviation; MD, mean difference
Fig. 4
Fig. 4
Forest plot: a meta-analysis of the duration of SARS-CoV-2 RNA positivity in various samples. The duration of SARS-CoV-2 RNA positivity from the onset of COVID-19 in the blood (a) and stool (c) was calculated using the random effects model. The difference in the duration of SARS-CoV-2 RNA positivity between the blood and upper respiratory tract samples was calculated using the random effects model (b). Experimental meant the blood samples and control meant the upper respiratory tract samples. The difference in the duration of SARS-CoV-2 RNA positivity between the stool and upper respiratory tract samples was calculated using the random effects model (d). Experimental meant the stool and control meant the upper respiratory tract samples. MRAW, the raw data of mean; 95%-CI, 95% confidence interval; SD, standard deviation; MD, mean difference
Fig. 5
Fig. 5
Sensitivity analysis based on the clinical characteristics in upper respiratory tract samples. The association between the duration of SARS-CoV-2 RNA positivity from the onset of COVID-19 in upper respiratory tract samples and mean age (a), the proportion of women (b), the proportion of patients with any comorbidities (c), the proportion of patients with compromised status (d), the proportion of severe patients (e), and the proportion of patients treated with glucocorticoid (f) in each study. The correlation was evaluated using the Spearman correlation coefficient
Fig. 6
Fig. 6
Forest plot: a meta-analysis of the duration of SARS-CoV-2 RNA positivity in the upper respiratory tract sample based on age and comorbidities. The duration of SARS-CoV-2 RNA positivity from the onset of COVID-19 in the patients over the age of 60 (a), patients under the age of 60 (b), patients with any comorbidities (c), patients without any comorbidities patients (d) was calculated using the random effects model. MRAW, the raw data of mean; 95%-CI, 95% confidence interval
Fig. 7
Fig. 7
Forest plot: a meta-analysis of the duration of SARS-CoV-2 RNA positivity in the upper respiratory tract samples based on the severity. The duration of SARS-CoV-2 RNA positivity from the onset of COVID-19 in the severe patients (a) and the nonsevere patients (b) was calculated using the random effects model. The duration of SARS-CoV-2 RNA positivity from the onset of COVID-19 in the severe patients (c) and the nonsevere patients (d) from the studies with the mean age of 40 years or older and the proportion of patients with any comorbidities of 30% or more was calculated using the random effects model. MRAW, the raw data of mean; 95%-CI, 95% confidence interval
Fig. 8
Fig. 8
Forest plot: a meta-analysis of the duration of SARS-CoV-2 RNA positivity in the upper respiratory tract samples based on the usage of glucocorticoid. The duration of SARS-CoV-2 RNA positivity from the onset of COVID-19 in the patients treated with glucocorticoid (a) and the patients treated without glucocorticoid (b) was calculated using the random effects model. The duration of SARS-CoV-2 RNA positivity from the onset of COVID-19 in the patients treated with glucocorticoid (c) and the patients treated without glucocorticoid (d) from the studies with the mean age of 30–60 years and the proportion of patients with any comorbidities of 50% or less was calculated using the random effects model. MRAW, the raw data of mean; 95%-CI, 95% confidence interval
Fig. 9
Fig. 9
Forest plot: subgroup meta-analysis of the duration of SARS-CoV-2 RNA positivity from the onset of COVID-19 in the upper respiratory tract samples based on the locality. The duration of SARS-CoV-2 RNA positivity from the onset of COVID-19 in the Asian countries (a) and European countries (b) was calculated using the random effects model. The duration of SARS-CoV-2 RNA positivity from the onset of COVID-19 in the Asian countries (c) and European countries (d) from the studies with the mean age of 40 years or older and the proportion of severe patients of 40% or more was calculated using the random effects model. MRAW, the raw data of mean; 95%-CI, 95% confidence interval
Fig. 10
Fig. 10
The summary of the duration of SARS-CoV-2 RNA positivity in the various samples and the clinical characteristics
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