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Impact Factors of Viral Shedding in Patients with SARS-CoV-2 Infected Pneumonia
21 Pages Posted: 21 Apr 2020
More...Abstract
Background: Severe acute respiratory coronavirus 2 (SARS-CoV-2) infected pneumonia suddenly outbreak in 2019 in Wuhan, China. The duration of viral RNA shedding is unclear. We aimed to analyze the duration of viral RNA shedding and risk factors for prolonged shedding time in a large cohort.
Methods: In this multicenter, retrospective, observational study, we enrolled 410 patients with SARS-CoV-2 pneumonia discharged from Wuhan Union hospital, Tongji hospital and Jin Yin-tan hospital between February 1 and February 20, 2020. Demographic characteristics, symptoms, laboratory tests, radiological examination, comorbidities, and treatments were all collected. The clinical characteristics were compared between patients with different duration of viral shedding, and factors impacting the duration of viral shedding were also analyzed.
Findings: Of these 410 patients, the viral RNA of most patients (89%) turned negative within 26 days after symptom onset, and the median time was 19 days. The median time from the date of normalized temperature to the date of negative SARS-CoV-2 RNA test was 7 days (IQR 4·0-10·0). Age (p=0·055), gender (p=0·594), disease severity status (p=0·742), corticosteroid (p=0·656), and antibacterial therapy (p=0·927) were not associated with the duration of viral RNA shedding. Coronary heart disease (HR,0·619[95%CI,0·411-0·933],p=0·022), the level of albumin extremum (HR,1·027[95%CI,1·005-1·049], p=0·014), and the initial time for antiviral treatment after illness onset (HR,1·467[95%CI,1·187-1·815],p<0·001) were independent factors of the duration of SARS-CoV-2 RNA shedding.
Interpretation: Most patients may need follow up for about 26 days after symptom onset. It is more likely to achieve negative nucleic acid test results when reexamined 7 days after body temperature recovered. Low serum albumin levels, concomitant coronary heart disease, and starting antiviral therapy more than 7 days after symptom onset may prolong the duration of SARS-CoV-2 RNA shedding.
Funding Statement: This study is funded by Natural Science Foundation of China [grant number 81570501, 81770554, 81772607, 81974383] and Key Projects in the Natural Scientific and Technology Program (2018ZX10302204-002-003).
Declaration of Interests: All authors declare no competing interests.
Ethics Approval Statement: This study was approved by the ethics commission of the above three hospitals (S2020-055, S2020-056, 2020-YJ-046.01) and requirement of informed consent was waived.
Keywords: SARS-CoV-2; COVID-19; Viral shedding
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