Corticosteroid, oseltamivir and delayed admission are independent risk factors for prolonged viral shedding in patients with Coronavirus Disease 2019
Corticosteroid, oseltamivir and delayed admission are independent risk factors for prolonged viral shedding in patients with Coronavirus Disease 2019
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皮质类固醇、奥司他韦和延迟入院是 2019 年冠状病毒病患者病毒排毒时间延长的独立危险因素
DOI：
10.1111/crj.13243
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发表时间：
2020-08-13
影响因子：
1.7
通讯作者：
Zhang, Yong
中科院分区：
文献类型：
--
作者：
Hu, Fuying;Yin, Gang;Zhang, Yong
2019冠状病毒病（COVID-19）已在全球范围内蔓延，并已达到超过1450万例。尽管湖北省是中国的震中，但对武汉周围湖北省其他地区COVID-19的流行病学和临床特征知之甚少。此外，病毒学数据，特别是与COVID-19病毒脱落相关的因素尚未得到很好的描述。目的了解天门市2019冠状病毒病（COVID-19）患者的流行病学和临床特征，并分析影响COVID-19持续排毒的危险因素。方法纳入2020年2月9日之前收治的新冠肺炎住院患者。比较了早期和晚期病毒RNA脱落患者的特征。多变量考克斯回归模型用于研究与病毒脱落时间延长相关的变量。结果共纳入183例患者。约8.2%的患者被归类为危重程度。所有患者均接受抗病毒治疗，阿比朵尔和干扰素是最常见的。分别有38.3%和16.9%的患者使用糖皮质激素和免疫球蛋白。发病至入院时间（HR = 0.829，P < 0.001）、糖皮质激素（HR = 0.496，P = 0.002）、阿比朵尔（HR = 2.605，P = 0.008）和奥司他韦（HR = 0.416，P < 0.001）与病毒排出时间独立相关。结论天门市患者症状较轻。治疗应尽早开始，但皮质类固醇和奥司他韦应谨慎开始。此外，应开展阿比朵尔的临床试验以证明其有效性。
Introduction Coronavirus Disease 2019 (COVID-19) has spread worldwide, and it has reached to more than 14.5 million cases. Although Hubei province is the epicenter of China, little is known about epidemiological and clinical features of COVID-19 in other areas in Hubei province around Wuhan. In addition, the virological data, particularly the factors associated with viral shedding of COVID-19 has not been well described. Objective To describe the epidemiological and clinical features of patients with COVID-19 in Tianmen city, and identify risk factors associated with prolonged viral shedding of COVID-19. Methods Inpatients with COVID-19 admitted before February 9, 2020 were included. Characteristics were compared between patients with early and late viral RNA shedding. Multivariate cox regression model was used to investigate variables associated with prolonged viral shedding. Results One hundred and eighty-three patients were included. About 8.2% patients were categorized as critical degree of severity. All patients received antiviral therapy, with arbidol and interferon being the commonest. About 38.3% and 16.9% patients were treated with corticosteroid and immunoglobulin, respectively. Time from onset to admission (HR = 0.829,P < 0.001), and administration of corticosteroid (HR = 0.496,P = 0.002), arbidol (HR = 2.605,P = 0.008) and oseltamivir (HR = 0.416,P < 0.001) were independently associated with duration of viral shedding. Conclusion Symptoms of patients from Tianmen are relatively mild. Treatment should be started as early as possible, but corticosteroid and oseltamivir should be initiated with caution. In addition, clinical trials on arbidol should be conducted to demonstrate its effectiveness.