Delayed Clearance of Viral RNA in Sputum for Severity COVID-19 Patients with Initial High Viral Load

Abstract

Aim To analyze the possible risk factors of delayed virus clearance in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods Retrospective analysis of patients with COVID-19 admitted to the isolation wards from our hospital from 19th Jan 2020 to 18th March 2020. We were collected patient’s data including demographic, epidemiologic, and clinical information, as well as laboratory and radiologic findings. The possible confounding risk factors for prolonged viral RNA shedding of COVID-19 during hospitalization were explored by univariate analysis and any variables with a p value less than 0.05 after univariate analysis were included in a subsequent multivariate logistic regression model analysis. Results The 104 patients included 30 mild patients and 74 severe or critically ill patients. The median duration of viral RNA positivity in sputum was 11 days, and the longest duration of viral RNA positivity was 49 days after admission. Multivariate analysis shown that the used with darunavir/cobicistat treatment (odds ratio [OR]: 4.25, 95% confidence interval [CI]: 1.25–14.42, p = 0.020), duration of fever (OR: 1.15, 95% CI: 1.03–1.30, p = 0.015) and time to radiological improvement (OR: 1.14, 95% CI: 1.01–1.30, p = 0.033) were associated with delayed clearance of SARS-CoV-2 in sputum from COVID-19 patients. Then adjusted in the multivariate binary logistic regression analysis model in severe COVID-19 and found that critical COVID-19 patients (OR: 13.25, 95% CI: 1.45–12.07, p = 0.022), lower virus cycle threshold (CT) values of RT-PCR (OR: 0.96, 95% CI: 0.93–0.99, p = 0.004) and used with darunavir/cobicistat treatment (OR: 8.44, 95% CI: 2.21–32.28, p = 0.022) were associated with delayed clearance of SARS-CoV-2 in sputum from COVID-19 patients. Conclude Clearance of viral RNA in sputum was delayed in severe COVID-19 patients, especially with lower virus CT value. And antivirals with darunavir/cobicistat has little advantage in eliminating SARS-CoV-2.

Clinical characteristics and risk factors for a prolonged length of stay of patients with asymptomatic and mild COVID-19 during the wave of Omicron from Shanghai, China

“…The Ct values of RT-PCR tests for SARS-CoV-2 are the most acknowledged and convenient indicator for viral load in COVID-19 patients at present [27,28]. The low Ct values were shown to be associated with delayed clearance of viral RNA in patients infected with previous SARS-CoV-2 variants [8,9], and our findings further supported that it could be the same case in Omicron-infected patients. A recent study showed that the symptomatic COVID-19 cases across each variant, including Omicron, had higher viral loads than the asymptomatic cases [22].…”

“…A few studies on COVID-19 patients during the Omicron wave showed that their median length of hospital stay (LOS) was 3-3.2 days [4,5]. Meanwhile, age, more severe clinical symptoms, non-vaccination, comorbidities, and low cycle threshold (Ct) values of the RT-PCR tests were shown to be associated with prolonged viral clearance and LOS in patients infected with previous variants [6][7][8][9][10]. Since Omicron is the dominant disease-causing variant at present and the majority of Omicron-infected COVID-19 patients were reported to be asymptomatic and mild cases [11][12][13][14][15], this study aims to demonstrate the clinical characteristics and LOS in a cohort of asymptomatic and mild COVID-19 patients during the wave of the Omicron epidemic in Shanghai from the largest municipal-level makeshift hospital with a capacity of 50,000 beds, the National Exhibition and Convention Center (NECC) Makeshift Hospital, and to investigate the risk factors for the prolonged LOS due to prolonged duration of viral shedding.…”

Clinical predictors and RT-PCR profile of prolonged viral shedding in patients with SARS-CoV-2 Omicron variant in Shanghai: A retrospective observational study

“…The median duration of viral shedding of these prolong RNA positive patients was 16 days (IQR, 15-18 days), while seven (6-8) in control group. The median duration of these prolonged RNA positive patients testing negative first was 3 days (IQR, 3-5 days), while eight (5)(6)(7)(8)(9)(10)(11) in control group (Table 1…”

“…They found that delayed admission to hospital, male, and invasive mechanical ventilation were independent factors associated with the duration of SARS-CoV-2 RNA shedding. Zhao et al ( 9 ) retrospectively analyzed 104 patients with COVID-19 admitted to the isolation wards of our hospital from January 19 to March 18, 2020. The result showed that the clearance of viral RNA in sputum was delayed in severe COVID-19 patients, especially in those with a lower virus cycle threshold (Ct) value.…”

Omicron COVID-19 variant outcomes and vaccination in non-severe and non-critical patients at admission

“…Omicron COVID-19 variant-infected individuals were identified using a reverse transcription PCR and the subsequent genomic sequencing. Asymptomatic, mild, moderate, severe, and critically ill patients were defined as previously described ( 7 – 9 ). Subjects who received other types of vaccines were excluded.…”