Abstract Objectives A wide range of duration of viral RNA shedding in patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) has been observed. We aimed to investigate factors associated with prolonged and intermittent viral RNA shedding in a retrospective cohort of symptomatic COVID‐19 patients. Methods Demographic, clinical and laboratory data from hospitalised COVID‐19 patients from a single centre with two consecutive negative respiratory reverse transcription‐polymerase chain reaction (RT‐PCR) results were extracted from electronic medical records. Kaplan–Meier survival curve analysis was used to assess the effect of clinical characteristics on the duration and pattern of shedding. Plasma levels of immune mediators were measured using Luminex multiplex microbead‐based immunoassay. Results There were 201 symptomatic patients included. Median age was 49 years (interquartile range 16–61), and 52.2% were male. Median RNA shedding was 14 days (IQR 9–18). Intermittent shedding was observed in 77 (38.3%). We did not identify any factor associated with prolonged or intermittent viral RNA shedding. Duration of shedding was inversely correlated with plasma levels of T‐cell cytokines IL‐1β and IL‐17A at the initial phase of infection, and patients had lower levels of pro‐inflammatory cytokines during intermittent shedding. Conclusions Less active T‐cell responses at the initial phase of infection were associated with prolonged viral RNA shedding, suggesting that early immune responses are beneficial to control viral load and prevent viral RNA shedding. Intermittent shedding is common and may explain re‐detection of viral RNA in recovered patients. We studied 201 patients with PCR‐confirmed COVID‐19 infection. We found median RNA shedding was 14 days and intermittent RNA shedding was observed in 38.3%. The only associated clinical factor with prolonged RNA shedding was invasive mechanical ventilation. Importantly, we observed in a subset of patients with cytokine analysis, that prolonged RNA shedding was associated with EGF, FGF‐2, GRO‐α and RANTES at the initial phase of infection. Intermittent RNA shedding was associated with lower levels of pro‐inflammatory cytokines.
【저자키워드】 COVID‐19, Cytokines, SARS‐CoV‐2, immune responses, Viral RNA shedding, 【초록키워드】 Clinical characteristics, Infection, cytokine, coronavirus 2, immune, RNA, SARS‐CoV‐2, immunoassay, Duration, survival, Viral load, symptomatic, male, Patient, plasma, age, Viral RNA, recovered patients, respiratory, multiplex, electronic medical records, demographic, Invasive mechanical ventilation, Analysis, interquartile range, Factor, COVID‐19 patients, laboratory data, COVID‐19 infection, retrospective cohort, RANTES, RT‐PCR, Cytokine analysis, Kaplan–Meier, hospitalised, objective, Prevent, EGF, initial, Result, identify, was used, median, correlated, subset, explain, were measured, COVID‐19 patient, early immune response, IL‐17A, Intermittent, IQR, Plasma level, symptomatic patient, T‐cell, T‐cell response, 【제목키워드】 immune response, Infection, coronavirus 2, RNA, SARS‐CoV‐2, respiratory, viral ribonucleic acid,