Abstract Background The dynamic alteration and comparative study of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) RNA shedding pattern during treatment are limited. This study explores the potential risk factors influencing prolonged viral shedding in COVID‐19. Methods A total of 126 COVID‐19 patients were enrolled in this retrospective longitudinal study. A multivariate logistic regression analysis was carried out to estimate the potential risk factors. Results 38.1% (48/126) cases presented prolonged respiratory tract viral shedding, and 30 (23.8%) cases presented prolonged rectal swab viral shedding. Obesity ( OR , 3.31; 95% CI, 1.08–10.09), positive rectal swab ( OR , 3.43; 95% CI, 1.53–7.7), treatment by lopinavir/ritonavir with chloroquine phosphate ( OR , 2.5; 95% CI, 1.04–6.03), the interval from onset to antiviral treatment more than 7 days ( OR , 2.26; 95% CI, 1.04–4.93), lower CD4+ T cell ( OR , 0.92; 95% CI, 0.86–0.99) and higher NK cells ( OR , 1.11; 95% CI, 1.02–1.20) were significantly associated with prolonged respiratory tract viral shedding. CD3−CD56+ NK cells ( OR , 0.87; 95% CI, 0.76–0.99) were related with prolonged fecal shedding. Conclusions Obesity, delayed antiviral treatment, and positive SARS‐CoV‐2 for stool were independent risk factors for prolonged SARS‐CoV‐2 RNA shedding of the respiratory tract. A combination of LPV/r and abidol as the initial antiviral regimen was effective in shortening the duration of viral shedding compared with LPV/r combined with chloroquine phosphate. CD4+ T cell and NK cells were significantly associated with prolonged viral shedding, and further studies are to be warranted to determine the mechanism of immunomodulatory response in virus clearance. The multivariable logistic regression analysis suggested that BMI ( OR , 3.32; 95% CI, 1.08–10.0), positive rectal swab ( OR , 3.43; 95% CI, 1.53–7.7), treatment by lopinavir/ritonavir with chloroquine phosphate ( OR , 2.5; 95% CI, 1.04–6.03), interval from onset to antiviral treatment more than 7 days ( OR , 2.26; 95% CI, 1.04–4.93), lower CD4+ T cell ( OR , 0.92; 95% CI, 0.86–0.99) and higher NK cells ( OR , 1.11; 95% CI, 1.02–1.20) were significantly associated with prolonged respiratory tract viral shedding even after adjustment for age and gender. Additionally, CD3−CD56+ NK cells ( OR , 0.87; 95% CI: 0.76–0.99) on admission were linked to prolonged fecal shedding.
【저자키워드】 COVID‐19, SARS‐CoV‐2, risk factor, longitudinal study, prolonged viral shedding, 【초록키워드】 Treatment, coronavirus, Chloroquine, Lopinavir/ritonavir, Antiviral, obesity, Lopinavir, Ritonavir, NK cell, viral shedding, NK cells, Antiviral treatment, severe acute respiratory syndrome Coronavirus, Chloroquine phosphate, COVID‐19, RNA, SARS‐CoV‐2, Stool, T cell, Viral, longitudinal study, immunomodulatory, Factors, respiratory tract, BMI, respiratory, pattern, prolonged viral shedding, Admission, mechanism, CD4+ T cell, retrospective, Combination, Analysis, fecal, regimen, on admission, phosphate, during treatment, acute respiratory syndrome, Factor, 95% CI, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, virus clearance, independent risk factors, multivariable logistic regression, potential risk, multivariate logistic regression, independent risk factor, multivariate logistic regression analysis, Multivariable logistic regression analysis, positive, rectal swab, effective, initial, Result, enrolled, carried, significantly, determine, suggested, age and gender, COVID‐19 patient, 【제목키워드】 Infection, virus, fecal, acute respiratory syndrome, Factor,