Determinants of prolonged viral RNA shedding in hospitalized patients with SARS-CoV-2 infection

https://doi.org/10.1016/j.diagmicrobio.2021.115347Get rights and content

Highlights

  • Prevention of transmission is crucial to reduce the global spread of SARS-CoV-2.

  • The kinetic of viral shedding in COVID-19 is still unknown.

  • It is of urgent need to elucidate the determinants of viral shedding duration.

  • Tocilizumab and corticosteroids are independent predictors of viral persistence.

  • Elderly and albumin are associated with prolonged SARS-CoV-2 RNA shedding.

  • The great dilemma, “shedding vs infectivity”, is still open and actual.

Abstract

Objective: To evaluate determinants of prolonged viral RNA shedding in hospitalized patients with SARS-CoV-2 infection. Materials and methods: Hospitalized patients with SARS-CoV-2 positive nasopharyngeal RT-PCR were included in a single-center, retrospective study. Patients were divided in 2 groups according to the timing of viral clearance [≤14 days, “early clearance (EC)” and >14 days, “late clearance (LC)”]. Results: 179 patients were included in the study (101 EC, 78 LC), with median age 62 years. Median time of viral shedding was 14 days (EC/LC 10 and 19 days, respectively, P < 0.0001). Univariate analyses showed that age, male gender, receiving corticosteroids, receiving tocilizumab, ICU admission, low albumin and NLR ratio were associated with late viral clearance. In the multivariable analysis, older age (P = 0.016), albumin level (P = 0.048), corticosteroids (P = 0.021), and tocilizumab (P = 0.015) were significantly associated with late viral clearance. Conclusions: Age, albumin, tocilizumab and corticosteroid treatment were independently associated with a prolonged SARS-CoV-2 RNA shedding.

Keywords

Viral shedding
SARS-CoV-2
tocilizumab
steroids
ICU admission

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These authors equally contributed to the manuscript.

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