Risk and predictive factors of prolonged viral RNA shedding in upper respiratory specimens in a large cohort of COVID-19 patients admitted to an Italian reference hospital.
COVID-19, viral clearance, viral shedding
Coronavirus
Risk factors
SARS-CoV-2
Journal
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
ISSN: 1878-3511
Titre abrégé: Int J Infect Dis
Pays: Canada
ID NLM: 9610933
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
16
11
2020
revised:
26
02
2021
accepted:
27
02
2021
pubmed:
7
3
2021
medline:
14
5
2021
entrez:
6
3
2021
Statut:
ppublish
Résumé
Limited data are available about the predictors and outcomes associated with prolonged SARS-CoV-2 RNA shedding (VS). A retrospective study including COVID-19 patients admitted to an Italian hospital between March 1 and July 1, 2020. Predictors of viral clearance (VC) and prolonged VS from the upper respiratory tract were assessed by Poisson regression and logistic regression analyses. The causal relation between VS and clinical outcomes was evaluated through an inverse probability weighted Cox model. The study included 536 subjects. The median duration of VS from symptoms onset was 18 days. The estimated 30-day probability of VC was 70.2%. Patients with comorbidities, lymphopenia at hospital admission, or moderate/severe respiratory disease had a lower chance of VC. The development of moderate/severe respiratory failure, delayed hospital admission after symptoms onset, baseline comorbidities, or D-dimer >1000ng/mL at admission independently predicted prolonged VS. The achievement of VC doubled the chance of clinical recovery and reduced the probability of death/mechanical ventilation. Respiratory disease severity, comorbidities, delayed hospital admission and inflammatory markers negatively predicted VC, which resulted to be associated with better clinical outcomes. These findings highlight the importance of prompt hospitalization of symptomatic patients, especially where signs of severity or comorbidities are present.
Sections du résumé
BACKGROUND
BACKGROUND
Limited data are available about the predictors and outcomes associated with prolonged SARS-CoV-2 RNA shedding (VS).
METHODS
METHODS
A retrospective study including COVID-19 patients admitted to an Italian hospital between March 1 and July 1, 2020. Predictors of viral clearance (VC) and prolonged VS from the upper respiratory tract were assessed by Poisson regression and logistic regression analyses. The causal relation between VS and clinical outcomes was evaluated through an inverse probability weighted Cox model.
RESULTS
RESULTS
The study included 536 subjects. The median duration of VS from symptoms onset was 18 days. The estimated 30-day probability of VC was 70.2%. Patients with comorbidities, lymphopenia at hospital admission, or moderate/severe respiratory disease had a lower chance of VC. The development of moderate/severe respiratory failure, delayed hospital admission after symptoms onset, baseline comorbidities, or D-dimer >1000ng/mL at admission independently predicted prolonged VS. The achievement of VC doubled the chance of clinical recovery and reduced the probability of death/mechanical ventilation.
CONCLUSIONS
CONCLUSIONS
Respiratory disease severity, comorbidities, delayed hospital admission and inflammatory markers negatively predicted VC, which resulted to be associated with better clinical outcomes. These findings highlight the importance of prompt hospitalization of symptomatic patients, especially where signs of severity or comorbidities are present.
Identifiants
pubmed: 33676001
pii: S1201-9712(21)00203-4
doi: 10.1016/j.ijid.2021.02.117
pmc: PMC7927669
pii:
doi:
Substances chimiques
RNA, Viral
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
532-539Investigateurs
Maria Alessandra Abbonizio
(MA)
Amina Abdeddaim
(A)
Elisabetta Agostini
(E)
Chiara Agrati
(C)
Fabrizio Albarello
(F)
Gioia Amadei
(G)
Alessandra Amendola
(A)
Andrea Antinori
(A)
Maria Assunta Antonica
(MA)
Mario Antonini
(M)
Tommaso Ascoli Bartoli
(TA)
Francesco Baldini
(F)
Raffaella Barbaro
(R)
Barbara Bartolini
(B)
Rita Bellagamba
(R)
Martina Benigni
(M)
Nazario Bevilacqua
(N)
Gianluigi Biava
(G)
Michele Bibas
(M)
Licia Bordi
(L)
Veronica Bordoni
(V)
Evangelo Boumis
(E)
Marta Branca
(M)
Rosanna Buonomo
(R)
Donatella Busso
(D)
Marta Camici
(M)
Paolo Campioni
(P)
Flaminia Canichella
(F)
Maria Rosaria Capobianchi
(MR)
Alessandro Capone
(A)
Cinzia Caporale
(C)
Emanuela Caraffa
(E)
Ilaria Caravella
(I)
Fabrizio Carletti
(F)
Concetta Castilletti
(C)
Adriana Cataldo
(A)
Stefano Cerilli
(S)
Carlotta Cerva
(C)
Roberta Chiappini
(R)
Pierangelo Chinello
(P)
Maria Assunta Cianfarani
(MA)
Carmine Ciaralli
(C)
Claudia Cimaglia
(C)
Nicola Cinicola
(N)
Veronica Ciotti
(V)
Stefania Cicalini
(S)
Francesca Colavita
(F)
Angela Corpolongo
(A)
Massimo Cristofaro
(M)
Salvatore Curiale
(S)
Alessandra D'Abramo
(A)
Cristina Dantimi
(C)
Alessia De Angelis
(A)
Giada De Angelis
(G)
Maria Grazia De Palo
(MG)
Federico De Zottis
(F)
Virginia Di Bari
(V)
Rachele Di Lorenzo
(R)
Federica Di Stefano
(F)
Gianpiero D'Offizi
(G)
Davide Donno
(D)
Francesca Evangelista
(F)
Francesca Faraglia
(F)
Anna Farina
(A)
Federica Ferraro
(F)
Lorena Fiorentini
(L)
Andrea Frustaci
(A)
Matteo Fusetti
(M)
Vincenzo Galati
(V)
Roberta Gagliardini
(R)
Paola Gallì
(P)
Gabriele Garotto
(G)
Ilaria Gaviano
(I)
Saba Gebremeskel Tekle
(SG)
Maria Letizia Giancola
(ML)
Filippo Giansante
(F)
Emanuela Giombini
(E)
Guido Granata
(G)
Maria Cristina Greci
(MC)
Elisabetta Grilli
(E)
Susanna Grisetti
(S)
Gina Gualano
(G)
Fabio Iacomi
(F)
Marta Iaconi
(M)
Giuseppina Iannicelli
(G)
Carlo Inversi
(C)
Giuseppe Ippolito
(G)
Eleonora Lalle
(E)
Maria Elena Lamanna
(ME)
Simone Lanini
(S)
Daniele Lapa
(D)
Luciana Lepore
(L)
Raffaella Libertone
(R)
Raffaella Lionetti
(R)
Giuseppina Liuzzi
(G)
Laura Loiacono
(L)
Andrea Lucia
(A)
Franco Lufrani
(F)
Manuela Macchione
(M)
Gaetano Maffongelli
(G)
Alessandra Marani
(A)
Luisa Marchioni
(L)
Andrea Mariano
(A)
Maria Cristina Marini
(MC)
Micaela Maritti
(M)
Annelisa Mastrobattista
(A)
Ilaria Mastrorosa
(I)
Giulia Matusali
(G)
Valentina Mazzotta
(V)
Paola Mencarini
(P)
Silvia Meschi
(S)
Francesco Messina
(F)
Sibiana Micarelli
(S)
Giulia Mogavero
(G)
Annalisa Mondi
(A)
Marzia Montalbano
(M)
Chiara Montaldo
(C)
Silvia Mosti
(S)
Silvia Murachelli
(S)
Maria Musso
(M)
Michela Nardi
(M)
Assunta Navarra
(A)
Emanuele Nicastri
(E)
Martina Nocioni
(M)
Pasquale Noto
(P)
Roberto Noto
(R)
Alessandra Oliva
(A)
Ilaria Onnis
(I)
Sandrine Ottou
(S)
Claudia Palazzolo
(C)
Emanuele Pallini
(E)
Fabrizio Palmieri
(F)
Giulio Palombi
(G)
Carlo Pareo
(C)
Virgilio Passeri
(V)
Federico Pelliccioni
(F)
Giovanna Penna
(G)
Antonella Petrecchia
(A)
Ada Petrone
(A)
Nicola Petrosillo
(N)
Elisa Pianura
(E)
Carmela Pinnetti
(C)
Maria Pisciotta
(M)
Pierluca Piselli
(P)
Silvia Pittalis
(S)
Agostina Pontarelli
(A)
Costanza Proietti
(C)
Vincenzo Puro
(V)
Paolo Migliorisi Ramazzini
(PM)
Alessia Rianda
(A)
Gabriele Rinonapoli
(G)
Silvia Rosati
(S)
Dorotea Rubino
(D)
Martina Rueca
(M)
Alberto Ruggeri
(A)
Alessandra Sacchi
(A)
Alessandro Sampaolesi
(A)
Francesco Sanasi
(F)
Carmen Santagata
(C)
Alessandra Scarabello
(A)
Silvana Scarcia
(S)
Vincenzo Schininà
(V)
Paola Scognamiglio
(P)
Laura Scorzolini
(L)
Giulia Stazi
(G)
Giacomo Strano
(G)
Fabrizio Taglietti
(F)
Chiara Taibi
(C)
Giorgia Taloni
(G)
Tetaj Nardi
(T)
Roberto Tonnarini
(R)
Simone Topino
(S)
Martina Tozzi
(M)
Francesco Vaia
(F)
Francesco Vairo
(F)
Maria Beatrice Valli
(MB)
Alessandra Vergori
(A)
Laura Vincenzi
(L)
Ubaldo Visco-Comandini
(U)
Serena Vita
(S)
Pietro Vittozzi
(P)
Mauro Zaccarelli
(M)
Antonella Zanetti
(A)
Sara Zito
(S)
Informations de copyright
Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.
Références
N Engl J Med. 2021 Feb 25;384(8):693-704
pubmed: 32678530
Clin Infect Dis. 2020 Nov 19;71(16):2240-2242
pubmed: 32302000
Pharmacol Res. 2020 Oct;160:105063
pubmed: 32663611
Chest. 2020 Nov;158(5):1876-1884
pubmed: 32569635
Lancet Infect Dis. 2020 Jun;20(6):656-657
pubmed: 32199493
J Infect Dis. 2021 Jan 4;223(1):15-18
pubmed: 33020822
J Med Virol. 2020 Nov;92(11):2286-2287
pubmed: 32347980
Lancet Microbe. 2021 Jan;2(1):e13-e22
pubmed: 33521734
Crit Care Med. 2017 Oct;45(10):1683-1695
pubmed: 28787295
JAMA. 2012 Jun 20;307(23):2526-33
pubmed: 22797452
Clin Infect Dis. 2020 Jul 28;71(15):799-806
pubmed: 32271376
J Intern Med. 2020 Dec;288(6):725-736
pubmed: 32959400
Nat Med. 2020 May;26(5):672-675
pubmed: 32296168
Infect Control Hosp Epidemiol. 2020 Oct 20;:1-10
pubmed: 33077007
Crit Care. 2020 Dec 14;24(1):696
pubmed: 33317589
BMJ. 2020 Apr 21;369:m1443
pubmed: 32317267
Am J Respir Crit Care Med. 2018 Mar 15;197(6):757-767
pubmed: 29161116
Nat Commun. 2021 Jan 11;12(1):267
pubmed: 33431879
Eur Respir J. 2020 Jul 2;56(1):
pubmed: 32398298
Clin Infect Dis. 2020 Nov 19;71(16):2249-2251
pubmed: 32306036
Euro Surveill. 2020 Jan;25(3):
pubmed: 31992387
J Infect. 2020 Jul;81(1):e78-e79
pubmed: 32283161
Lancet. 2020 Mar 28;395(10229):1054-1062
pubmed: 32171076
J Med Virol. 2021 Jan;93(1):506-512
pubmed: 32644223
Nature. 2020 May;581(7809):465-469
pubmed: 32235945
JAMA. 2020 Oct 6;324(13):1330-1341
pubmed: 32876694
Int J Infect Dis. 2020 Jul;96:531-537
pubmed: 32425636
J Infect Dis. 2018 May 5;217(11):1708-1717
pubmed: 29648602
Lancet Infect Dis. 2020 May;20(5):565-574
pubmed: 32213337
N Engl J Med. 2016 Sep 29;375(13):1303-5
pubmed: 27682053