Factors associated with prolonged viral RNA shedding in patients with COVID-19

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

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 coronavirus 2 (SARS-CoV-2) RNA shedding were evaluated in a cohort of 113 symptomatic patients from two hospitals outside Wuhan. RESULTS: The median duration of SARS-CoV-2 RNA detection was 17 days (Interquartile Range [IQR], 13–22 days) as measured from illness onset. When comparing patients with early (<15 days) and late viral RNA clearance (≥15 days after illness onset), prolonged SARS-CoV-2 RNA shedding was associated with male sex (p=0.009), old age (p=0.033), concomitated with hypertension (p=0.009), delayed admission to hospital after illness onset (p=0.001), severe illness at admission (p=0.049), invasive mechanical ventilation (p=0.006), and corticosteroid treatment (p=0.025). Patients with longer SARS-CoV-2 RNA shedding duration had slower recovery of body temperature (p<0.001) and focal absorption on radiograph images (p<0.001) than patients with early SARS-CoV-2 RNA clearance. Male sex (odds ratio [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.