Factors Associated With Prolonged Viral RNA Shedding in Patients with Coronavirus Disease 2019 (COVID-19)
Factors Associated With Prolonged Viral RNA Shedding in Patients with Coronavirus Disease 2019 (COVID-19)
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DOI：
10.1093/cid/ciaa351
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发表时间：
2020-08-01
影响因子：
11.8
通讯作者：
Li, Lanjuan
中科院分区：
文献类型：
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作者：
Xu, Kaijin;Chen, Yanfei;Li, Lanjuan
背景2019冠状病毒病（COVID-19）的爆发正在成为公共卫生紧急事件。数据是有限的持续时间和宿主因素相关的病毒脱落。本回顾性研究对武汉市外2家医院113例有症状患者进行SARS冠状病毒2型（SARSCoV-2）RNA脱落相关危险因素的评估。从发病开始测量，SARS-CoV-2 RNA检测的中位（四分位距）持续时间为17（13-22）天。当比较患者与早期（发病后15天）病毒RNA清除，延长SARS-CoV-2 RNA脱落与男性相关（P = 0.009），老年（P = .033），伴随高血压（P = .009），发病后延迟入院（P = 0.001）、入院时病情严重（P = 0.049）、有创机械通气（P = 0.006）和皮质类固醇治疗（P = 0.025）。与早期清除SARS-CoV-2 RNA的患者相比，具有较长SARS-CoV-2 RNA释放持续时间的患者体温恢复较慢（P <0.001），X线图像上的病灶吸收较慢（P <0.001）。男性（OR，3.24; 95%CI，1.31-8.02）、延迟入院（OR，1.30; 95%CI，1.10-1.54）和有创机械通气（OR，9.88; 95%CI，1.11-88.02）是延长SARS-CoV-2 RNA脱落的独立危险因素。男性、发病后延迟入院和有创机械通气与SARS-CoV-2 RNA脱落时间延长相关。对于有症状的COVID-19患者，尤其是男性患者，应尽快开始住院和一般治疗。
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 (SARSCoV-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 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.