Clinical Factors Associated with Progression and Prolonged Viral Shedding in COVID-19 Patients: A Multicenter Study

Abstract

Coronavirus disease 2019 (COVID-19) is a global pandemic associated with a high mortality. Our study aimed to determine the clinical risk factors associated with disease progression and prolonged viral shedding in patients with COVID-19. Consecutive 564 hospitalized patients with confirmed COVID-19 between January 17, 2020 and February 28, 2020 were included in this multicenter, retrospective study. The effects of clinical factors on disease progression and prolonged viral shedding were analyzed using logistic regression and Cox regression analyses. 69 patients (12.2%) developed severe or critical pneumonia, with a higher incidence in the elderly and in individuals with underlying comorbidities, fever, dyspnea, and laboratory and imaging abnormalities at admission. Multivariate logistic regression analysis indicated that older age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.06), hypertension without receiving angiotensinogen converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) therapy (OR, 2.29; 95% CI, 1.14-4.59), and chronic obstructive pulmonary disease (OR, 7.55; 95% CI, 2.44-23.39) were independent risk factors for progression to severe or critical pneumonia. Hypertensive patients without receiving ACEI/ARB therapy showed higher lactate dehydrogenase levels and computed tomography (CT) lung scores at about 3 days after admission than those on ACEI/ARB therapy. Multivariate Cox regression analysis revealed that male gender (hazard ratio [HR], 1.22; 95% CI, 1.02-1.46), receiving lopinavir/ritonavir treatment within 7 days from illness onset (HR, 0.75; 95% CI, 0.63-0.90), and receiving systemic glucocorticoid therapy (HR, 1.79; 95% CI, 1.46-2.21) were independent factors associated with prolonged viral shedding. Our findings presented several potential clinical factors associated with developing severe or critical pneumonia and prolonged viral shedding, which may provide a rationale for clinicians in medical resource allocation and early intervention.

A Comprehensive Summary of the Knowledge on COVID-19 Treatment

“…In the WHO-issued interim guidelines on “Clinical management of severe acute respiratory infection when COVID-19 is suspected” (published on March 13, 2020) [ 179 ], corticosteroids are not recommended unless otherwise indicated [ 180 ]. Nevertheless, some scholars think that the application of pulsed dose or long-term high dose, or early administration of corticosteroids to treat serious viral pneumonia can affect virus clearance rate [ 178 , 181 ] or survival [ 182 ]. On the contrary, some researchers found that adjuvant therapy with low-dose corticosteroids could reduce mortality in critical cases [ 183 ].…”

Shift in the Distributions of Pre-existing Medical Condition, Gender and Age across Different COVID-19 Outcomes

“…In our study, we observed major differences in the distributions of pre-existing medical conditions, gender, and age across different COVID-19 outcomes, improving our understanding of the risk factors related to COVID-19. Among various pre-existing medical conditions in COVID-19 patients, the most frequently reported diseases were cardiovascular diseases, diabetes, and chronic respiratory diseases [1][2][3][4]. The virus that causes COVID-19 is known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [5].…”

“…The fatality rate also increases with patients’ age [ 2 ]. A recent article published in Aging & Disease has reported that older age and pre-existing medical conditions of hypertension and chronic obstructive pulmonary diseases were independent risk factors for the progression to severe or critical pneumonia in 564 hospitalized COVID-19 patients [ 3 ], which have raised serious concerns. However, there is scarcity of data on the distributions of the pre-existing medical conditions, gender, and age across different COVID-19 outcomes in a large cohort.…”

Association Between Glucocorticoids Treatment and Viral Clearance Delay in Patients with COVID-19: A Systematic Review and Meta-Analysis

“…In uence analyses identi ed four studies 15,23,26,32 , with an excessive in uence on the overall results, of which two studies with extreme sample size are the excluded studies of predesign in the sensitivity analyses (Supplementary Figure 8). All the sensitivity analyses based on adjusted HRs showed a similar result with that from the main analysis (Supplementary Figure 1-7).…”