Risk factors for viral RNA shedding in COVID-19 patients

[摘要] Since there is an increasing number of coronavirus disease 2019 (COVID-19) cases confirmed in multiple countries around the world, resulting in alarmingly high mortality and morbidity [1], the World Health Organization has declared a global pandemic [2]. To our knowledge, most current research on COVID-19 focuses on the epidemiology, clinical features and treatment, but not on viral RNA shedding. Here, we discuss COVID-19 viral RNA conversion time and the risk factors associated with viral RNA shedding in a large patient cohort. A total of 410 laboratory-confirmed COVID-19 patients were recruited to this study, who were discharged from Wuhan Tongji hospital, Wuhan Jin Yin-tan hospital and Wuhan Union hospital main district (all in Wuhan, China) between 1 February 2020 and 20 February 2020. Throat-swab samples were collected and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was detected using real-time reverse transcription PCR (rRT-PCR). Data were extracted for demographic characteristics, comorbidities, symptoms, laboratory values and treatments using electronic medical records. All patients who were hospitalised received a standard diagnosis and treatment based on the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version 7) [3]. Follow-up throat-swab specimens were obtained at intervals of 4±2 days from when symptoms began to improve, including fever reduction or improvement in chest computed tomography scans. The date of symptom onset was defined as the day when initial symptoms were noticed. T1 referred to the duration from the symptom onset to when SARS-CoV-2 RNA was negative for two consecutive times, which indicated the duration of viral RNA shedding. The date of fever resolution was defined as the first day after admission when the axillary temperature of a patient was no longer >37.3°C. T2 was defined as the duration from the date of fever resolution to rRT-PCR conversion. A hazard ratio (HR) of <1 indicated prolonged viral RNA shedding. This study was approved by the ethics commission of all hospitals (S2020-055, S2020-056, 2020-YJ-046.01) where patients were observed, and the requirement for informed consent was waived.

[学科分类] 呼吸医学