Associations of Clinical Characteristics and Treatment Regimens with Viral RNA Shedding Duration in Patients with COVID-19

Chen, Xudan; Zhu, Baoyi; Hong, Wenxin; Zeng, Jianwen; He, Xi; Chen, Jingfeng; Zheng, Haipeng; Qiu, Shuang; Deng, Ying; Chan, Juliana CN; Wang, Jian; Zhang, Yuying

Abstract Objective The novel coronavirus disease 2019 (COVID-19) has become a global pandemic, but the factors influencing viral RNA shedding remain unclear to inform optimal control strategies. Methods The clinical course and viral RNA shedding pattern of 267 consecutive symptomatic COVID-19 patients admitted to the hospital from January 20, 2020 to March 15, 2020 were retrospectively evaluated. Results The median viral RNA shedding duration was 12 days (interquartile range, 8–16 d) after the onset of illness. Of the 267 patients included in this study, 65.2% had viral RNA cleared within 14 days, 88.8% within 21 days, and 94.4% within 28 days. Older age (hazard ratio [HR], 0.99; 95% confidence interval [CI]: 0.98–1.00; P = 0.04), time lag from illness onset to hospital admission (HR, 0.91; 95% CI: 0.88–0.94; P < 0.001), diarrhea (HR, 0.59; 95% CI: 0.36–0.96; P = 0.036), corticosteroid treatment (HR, 0.60; 95% CI: 0.39–0.94; P = 0.024), and lopinavir/ritonavir use (HR, 0.70; 95% CI: 0.52–0.94; P = 0.014) were significantly independently associated with prolonged viral RNA shedding. Conclusions Early detection and timely hospital admission may be warranted for symptomatic COVID-19 patients, especially for older patients and patients with diarrhea. Corticosteroid treatment is associated with prolonged viral RNA shedding and should be used with caution. Lopinavir/ritonavir use may be associated with prolonged viral RNA shedding in non-severe patients; further randomized controlled trials are needed to confirm this finding.