tetano
Editor, Senior Moderator
J Clin Lab Anal
. 2021 Aug 13;e23923.
doi: 10.1002/jcla.23923. Online ahead of print.
Risk factors for prolonged virus shedding of respiratory tract and fecal in adults with severe acute respiratory syndrome coronavirus-2 infection
Shun Zhang[SUP] 1 2 [/SUP], Hui Zhu[SUP] 1 2 [/SUP], Honghua Ye[SUP] 3 [/SUP], Yaoren Hu[SUP] 2 4 [/SUP], Nanhong Zheng[SUP] 4 [/SUP], Zuoan Huang[SUP] 1 2 [/SUP], Zi Xiong[SUP] 1 2 [/SUP], Liyun Fu[SUP] 2 4 [/SUP], Ting Cai[SUP] 1 2 [/SUP]
Affiliations
Abstract
Background: The dynamic alteration and comparative study of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding pattern during treatment are limited. This study explores the potential risk factors influencing prolonged viral shedding in COVID-19.
Methods: A total of 126 COVID-19 patients were enrolled in this retrospective longitudinal study. A multivariate logistic regression analysis was carried out to estimate the potential risk factors.
Results: 38.1% (48/126) cases presented prolonged respiratory tract viral shedding, and 30 (23.8%) cases presented prolonged rectal swab viral shedding. Obesity (OR, 3.31; 95% CI, 1.08-10.09), positive rectal swab (OR, 3.43; 95% CI, 1.53-7.7), treatment by lopinavir/ritonavir with chloroquine phosphate (OR, 2.5; 95% CI, 1.04-6.03), the interval from onset to antiviral treatment more than 7 days (OR, 2.26; 95% CI, 1.04-4.93), lower CD4+ T cell (OR, 0.92; 95% CI, 0.86-0.99) and higher NK cells (OR, 1.11; 95% CI, 1.02-1.20) were significantly associated with prolonged respiratory tract viral shedding. CD3-CD56+ NK cells (OR, 0.87; 95% CI, 0.76-0.99) were related with prolonged fecal shedding.
Conclusions: Obesity, delayed antiviral treatment, and positive SARS-CoV-2 for stool were independent risk factors for prolonged SARS-CoV-2 RNA shedding of the respiratory tract. A combination of LPV/r and abidol as the initial antiviral regimen was effective in shortening the duration of viral shedding compared with LPV/r combined with chloroquine phosphate. CD4+ T cell and NK cells were significantly associated with prolonged viral shedding, and further studies are to be warranted to determine the mechanism of immunomodulatory response in virus clearance.
Keywords: COVID-19; SARS-CoV-2; longitudinal study; prolonged viral shedding; risk factor.
. 2021 Aug 13;e23923.
doi: 10.1002/jcla.23923. Online ahead of print.
Risk factors for prolonged virus shedding of respiratory tract and fecal in adults with severe acute respiratory syndrome coronavirus-2 infection
Shun Zhang[SUP] 1 2 [/SUP], Hui Zhu[SUP] 1 2 [/SUP], Honghua Ye[SUP] 3 [/SUP], Yaoren Hu[SUP] 2 4 [/SUP], Nanhong Zheng[SUP] 4 [/SUP], Zuoan Huang[SUP] 1 2 [/SUP], Zi Xiong[SUP] 1 2 [/SUP], Liyun Fu[SUP] 2 4 [/SUP], Ting Cai[SUP] 1 2 [/SUP]
Affiliations
- PMID: 34390043
- DOI: 10.1002/jcla.23923
Abstract
Background: The dynamic alteration and comparative study of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding pattern during treatment are limited. This study explores the potential risk factors influencing prolonged viral shedding in COVID-19.
Methods: A total of 126 COVID-19 patients were enrolled in this retrospective longitudinal study. A multivariate logistic regression analysis was carried out to estimate the potential risk factors.
Results: 38.1% (48/126) cases presented prolonged respiratory tract viral shedding, and 30 (23.8%) cases presented prolonged rectal swab viral shedding. Obesity (OR, 3.31; 95% CI, 1.08-10.09), positive rectal swab (OR, 3.43; 95% CI, 1.53-7.7), treatment by lopinavir/ritonavir with chloroquine phosphate (OR, 2.5; 95% CI, 1.04-6.03), the interval from onset to antiviral treatment more than 7 days (OR, 2.26; 95% CI, 1.04-4.93), lower CD4+ T cell (OR, 0.92; 95% CI, 0.86-0.99) and higher NK cells (OR, 1.11; 95% CI, 1.02-1.20) were significantly associated with prolonged respiratory tract viral shedding. CD3-CD56+ NK cells (OR, 0.87; 95% CI, 0.76-0.99) were related with prolonged fecal shedding.
Conclusions: Obesity, delayed antiviral treatment, and positive SARS-CoV-2 for stool were independent risk factors for prolonged SARS-CoV-2 RNA shedding of the respiratory tract. A combination of LPV/r and abidol as the initial antiviral regimen was effective in shortening the duration of viral shedding compared with LPV/r combined with chloroquine phosphate. CD4+ T cell and NK cells were significantly associated with prolonged viral shedding, and further studies are to be warranted to determine the mechanism of immunomodulatory response in virus clearance.
Keywords: COVID-19; SARS-CoV-2; longitudinal study; prolonged viral shedding; risk factor.