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Observational Study
. 2020 Jul 28;71(15):799-806.
doi: 10.1093/cid/ciaa351.

Factors Associated With Prolonged Viral RNA Shedding in Patients with Coronavirus Disease 2019 (COVID-19)

Kaijin Xu  1 , Yanfei Chen  1 , Jing Yuan  2 , Ping Yi  1 , Cheng Ding  1 , Wenrui Wu  1 , Yongtao Li  1 , Qin Ni  1 , Rongrong Zou  2 , Xiaohe Li  2 , Min Xu  1 , Ying Zhang  1 , Hong Zhao  1 , Xuan Zhang  1 , Liang Yu  1 , Junwei Su  1 , Guanjing Lang  1 , Jun Liu  1 , Xiaoxin Wu  1 , Yongzheng Guo  1 , Jingjing Tao  1 , Ding Shi  1 , Ling Yu  1 , Qing Cao  1 , Bing Ruan  1 , Lei Liu  2 , Zhaoqin Wang  2 , Yan Xu  1 , Yingxia Liu  2 , Jifang Sheng  1 , Lanjuan Li  1
Affiliations
Observational Study

Factors Associated With Prolonged Viral RNA Shedding in Patients with Coronavirus Disease 2019 (COVID-19)

Kaijin Xu et al. Clin Infect Dis. .

Abstract

Background: An outbreak of coronavirus disease 2019 (COVID-19) is becoming a public health emergency. Data are limited on the duration and host factors related to viral shedding.

Methods: In this retrospective study, risk factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding were evaluated in a cohort of 113 symptomatic patients from 2 hospitals outside Wuhan.

Results: The median (interquartile range) duration of SARS-CoV-2 RNA detection was 17 (13-22) days as measured from illness onset. When comparing patients with early (<15 days) and late (≥15 days after illness onset) viral RNA clearance, prolonged SARS-CoV-2 RNA shedding was associated with male sex (P = .009), old age (P = .033), concomitant hypertension (P = .009), delayed admission to hospital after illness onset (P = .001), severe illness at admission (P = .049), invasive mechanical ventilation (P = .006), and corticosteroid treatment (P = .025). Patients with longer SARS-CoV-2 RNA shedding duration had slower recovery of body temperature (P < .001) and focal absorption on radiograph images (P < .001) than patients with early SARS-CoV-2 RNA clearance. Male sex (OR, 3.24; 95% CI, 1.31-8.02), delayed hospital admission (OR, 1.30; 95% CI, 1.10-1.54), and invasive mechanical ventilation (OR, 9.88; 95% CI, 1.11-88.02) were independent risk factors for prolonged SARS-CoV-2 RNA shedding.

Conclusions: Male sex, delayed admission to hospital after illness onset, and invasive mechanical ventilation were associated with prolonged SARS-CoV-2 RNA shedding. Hospital admission and general treatments should be started as soon as possible in symptomatic COVID-19 patients, especially male patients.

Keywords: COVID-19; SARS-COV-2; coronavirus; risk factors; viral shedding.

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