Abstract
Prolonged viral shedding may pose a threat to the control of coronavirus disease-2019 (COVID-19), and data on the duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding are still limited, with the associated factors being unknown. All adult patients with laboratory-confirmed COVID-19 were included in this retrospective cross-sectional study in two designated hospitals during 21 January 2020 to 16 March 2020 in Anhui, China. In all patients, data on the duration of SARS-CoV-2 RNA shedding were analyzed by reviewing all RNA detection results during hospitalization. In addition, demographic, clinical, treatment, laboratory, and outcome data were also collected from electronic medical records. Factors associated with prolonged viral shedding were analyzed with the Cox proportional hazards model. Among 181 patients, the mean age was 44.3 ± 13.2 years, and 55.2% were male. The median duration of viral shedding from illness onset was 18.0 days (interquartile range [IQR], 15.0-24.0). Prolonged viral shedding was associated with longer hospital stays (P < .001) and higher medical costs (P < .001). The severity of COVID-19 had nothing to do with prolonged shedding. Moreover, the median time from onset to antiviral treatment initiation was 5.0 days (IQR, 3.0-7.0). Delayed antiviral treatment (hazard ratio [HR], 0.976; 95% confidence interval [CI], 0.962-0.990]) and lopinavir/ritonavir + interferon-α (IFN-α) combination therapy as the initial antiviral treatment (HR 1.649; 95% CI, 1.162-2.339) were independent factors associated with prolonged SARS-CoV-2 RNA shedding. SARS-CoV-2 showed prolonged viral shedding, causing increased hospital stays and medical costs. Early initiation of lopinavir/ritonavir + IFN-α combination therapy may help shorten the duration of SARS-CoV-2 shedding.
Keywords: COVID-19; associated factors; outcomes; treatment; viral shedding.
【저자키워드】 COVID-19, Treatment, outcomes, Associated factors, Viral shedding., 【초록키워드】 coronavirus disease, SARS-CoV-2, coronavirus, Lopinavir/ritonavir, Hospitalization, hospital, Lopinavir, Ritonavir, interferon, viral shedding, combination therapy, Antiviral treatment, outcome, severe acute respiratory syndrome Coronavirus, Laboratory, coronavirus disease-2019, RNA, China, cross-sectional study, Viral, Cox proportional hazards model, severity of COVID-19, male, Patient, shedding, age, SARS-CoV-2 RNA, respiratory, electronic medical records, prolonged viral shedding, patients, Prolonged, Interferon-α, IFN-α, Hospital stay, medical records, medical costs, proportional hazards model, interquartile range, acute respiratory syndrome, Factor, 95% CI, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, 95% confidence interval, Laboratory-confirmed COVID-19, median time, hazard ratio, help, illness onset, laboratory-confirmed, Retrospective cross-sectional study, Delayed, independent, nothing, initial, analyzed, collected, addition, median, the mean, Cox proportional hazard, IQR, the median, 【제목키워드】 Lopinavir/ritonavir, hospital, China, Retrospective study, Viral, Patient, help,