Clinical characteristics of re-positive COVID-19 patients in Huangshi, China: A retrospective cohort study

Abstract

A cluster of patients with coronavirus disease 2019 (COVID-19) underwent repeated positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA tests after they were discharged from the hospital. We referred to them as re-positive (RP) patients in this study. We aimed to describe the clinical characteristics of these patients in a retrospective cohort study. After being treated for COVID-19, the patients underwent 14 days of quarantine following their discharge from the Huangshi Hospital of Traditional Chinese Medicine and the Huangshi Hospital of Youse. Two additional sequential SARS-CoV-2 RNA tests were performed at the end of quarantine. The median age of the 368 patients was 51 years, and 184 (50%) patients were female. A total of 23 RP patients were observed at follow-up. Using multivariate Cox regression analysis, risk factors associated with RP included a higher ratio of lymphocyte/white blood cell on admission (adjusted HR 7.038; 95% CI, 1.911–25.932; P = 0.0034), lower peak temperature during hospitalization (adjusted HR, 0.203; 95% CI, 0.093–0.443; P<0.0001), and the presence of comorbidities, particularly hypertension or chronic diseases in the respiratory system (adjusted HR, 3.883; 95% CI, 1.468–10.273; P = 0.0063). Antivirus treatment with arbidol was associated with a lower likelihood of re-positive outcomes (adjusted HR, 0.178; 95% CI, 0.045–0.709; P = 0.0144).

A systematic review and meta-analysis of discharged COVID-19 patients retesting positive for RT-PCR

“…Excluded studies and the reason are shown in appendix pp 107–110. Of the 117 eligible studies, there were 66 case reports [ 5 , 16 – 80 ], 42 case series [ 6 , 81 – 121 ], 3 cohort studies [ [122] , [123] , [124] ], 3 cross-sectional studies [ 125 – 127 ] and 3 case-control studies [ 128 – 130 ]. One hundred studies were from China, 7 from Italy, 3 from Korea, 2 from France, 5 each from Iran, Brunei Darussalam, Switzerland, America and Portugal.…”

“…During the second hospitalization, no RP patients showed any new symptoms, 78·31% showed further improved on chest CT scan compared with the first discharge. None of the close contacts developed COVID-19 Peng et al [117] China Case series 9 5 7·2 ± 4·8 14/38 – positive positive – positive Family cluster infection, higher WBC count, and longer plasma prothrombin time (PT) are the early risk factors for RP in recovered COVID‐19 children Landi et al [115] Italy Case series 10 12 56·4 ± 15·7 22/131 14 d positive – – – Persistent sore throat (prevalence ratio=6·50, 95% CI 1·38, 30·6) and symptoms of rhinitis (prevalence ratio=3·72, 95% CI 1·10, 12·5) were risk factors for retesting positive for SARS-CoV-2 Zhou et al [121] China Case series 16 7 51·0(42–58) 23/368 14 d positive – – – Using multivariate Cox regression analysis, risk factors associated with RP included a higher ratio of lymphocyte/white blood cell on admission, lower peak temperature during hospitalization, and the presence of comorbidities, particularly hypertension or chronic respiratory system diseases. Antivirus treatment with arbidol was associated with a lower likelihood of RP Huang et al [114] China Case series 41 28 – 69/417 14 d positive – – …”

“…Nineteen studies ( n = 101) [ 16 , 18 , 22 – 25 , 32 , 35 , 36 , 49 – 51 , 59 , 73 , 76 , 97 , 104 , 107 , 115 ] showed that discharged patients had no symptoms when the nucleic acid test was positive. Among 55 studies, 1054 RP patients had symptoms, cough (19·82%) [ 20 , 26 , 29 – 31 , 34 , 38 , 42 , 44 , 49 , 52 , 60 , 62 , 63 , 66 , 67 , 69 , 71 , 74 , 78 , 81 , 83 – 85 , 88 , 89 , 91 , 94 , 95 , 98 , 101 , 103 , 106 , 108 , 110 , 119 , 121 , 125 , 127 , 130 ] and fever (14·99%) [ 20 , 28 , 29 , 41 , 44 , 46 , 49 , 52 , 67 ,…”

“…Based on the results of included studies [ 83 , 98 , 99 , 107 , 110 , 112 , 115 , 117 , 118 , 121 , 129 ], we found that patients classified with a severe first episode [112] , aged 60 years and above [98] , and co-morbidities were more likely to be RP after discharge [ 99 , 121 ], especially those having hypertension or chronic respiratory diseases [121] .…”

“…When compared with the patients without RP results, the RP patients had a higher level of fever [ 107 , 129 ], a higher proportion with symptoms like diarrhea [118] , sore throat, and rhinitis [115] , and a higher level of some laboratory indices such as serum IL-6 [83] , ALT, AST [110] , erythrocyte sedimentation rate, D -dimer [129] , lymphocyte ratio [121] than those at the first hospitalization. However, neutrophil counts were comparatively lower [107] .…”