Clinical characteristics and factors associated with long-term viral excretion in patients with SARS-CoV-2 infection: a single center 28-day study

Shi, Ding; Wu, Wenrui; Wang, Qing; Xu, Kaijin; Xie, Jiaojiao; Wu, Jingjing; Lv, Longxian; Sheng, Jifang; Guo, Jing; Wang, Kaicen; Fang, Daiqiong; Li, Yating; Li, Lanjuan

BACKGROUND: Despite the ongoing spread of COVID-19, knowledge about factors affecting prolonged viral excretion is limited. METHODS: In this study, we retrospectively collected data from 99 hospitalized patients with COVID-19 between January 19 and February 17 in Zhejiang Province, China. We classified them into two groups based on whether the virus test results eventually became negative. Cox proportional hazards regression was used to evaluate factors associated with SARS-CoV-2 shedding. RESULTS: Among 99 patients, 61 patients had SARS-CoV-2 clearance (virus-negative group), but 38 patients had sustained positive results (virus-positive group). The median duration of SARS-CoV-2 excretion was 15 days (IQR 12-19) among the virus-negative patients. The shedding time was significantly increased if fecal SARS-CoV-2 RNA test results was positive. Male sex (HR, 0.58 [95% CI, 0.35-0.98]), immunoglobulin use (HR, 0.42 [95% CI, 0.24-0.76]), APACHE II score (HR, 0.89 [95% CI, 0.84-0.96]), and lymphocyte count (HR, 1.81 [95% CI, 1.05-3.1]) were independent factors associated with a prolonged duration of SARS-CoV-2 shedding. Antiviral therapy and corticosteroid treatment were not independent factors. CONCLUSIONS: SARS-CoV-2 RNA clearance time was associated with sex, disease severity and lymphocyte function. The current antiviral protocol and low-to-moderate dosage of corticosteroid had little effect on the duration of viral excretion.