COVID-19: prolonged viral shedding linked to male sex, lymphopenia, disease severity

  • Shi D & al.
  • J Infect Dis
  • 17 Aug 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • SARS-CoV-2 viral clearance appears to be influenced by male sex, disease severity, and lymphopenia.
  • Prolonged clearance time is also influenced by fecal viral RNA positivity.

Why this matters

  • High-dose corticosteroids do not appear to be more effective than moderate- to low-dose corticosteroids.
  • Longer isolated observation might be warranted in patients with positive fecal viral RNA.

Key results

  • 99 patients (61.6% male).
  • 61.6% (n=61) tested virus-negative and 38.4% (n=38) tested virus-positive after several days.
  • Median age: 54 years, with 22.2% aged >65 years.
  • Median time of persistent viral shedding: 16 (interquartile range, 13-21) days.
    • 19 days for virus positive vs 15 days for virus negative (P=.002).
  • Factors independently associated (HRs; 95% CIs) with longer SARS-CoV-2 RNA shedding on multivariate analysis:
    • Male sex: 0.58 (0.35-0.98).
    • Immunoglobulin use: 0.42 (0.24-0.76).
    • APACHE II score: 0.89 (0.84-0.96).
    • Lymphocyte count: 1.81 (1.05-3.10).
  • Patients with positive fecal samples took longer than those with negative fecal samples to clear the virus (log-rank, P=.003).

Study design

  • Single-center, retrospective cohort analysis characterizing factors influencing duration of SARS-CoV-2 shedding in patients with negative vs persistent positive virus detection during hospitalization.
  • Funding: Zhejiang Provincial Natural Science Foundation of China.

Limitations

  • 28-day cutoff point.
  • Limited generalizability.