Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Intensive Care Unit, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
J Med Virol. 2021 Feb;93(2):794-802. doi: 10.1002/jmv.26307. Epub 2020 Jul 27.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was found in the intestines and feces, but its clinical significance is not completely clear. We aim to characterize the longitudinal test results of SARS-CoV-2 RNA in anal swabs and to explore the association with disease severity.
We included laboratory-confirmed coronavirus disease 2019 (COVID-19) patients, who were hospitalized in Guangzhou Eighth People's Hospital and excluded those who had not received anal swabs for SARS-COV-2 RNA testing. Epidemiological, clinical, and laboratory data were obtained. Throat swabs and anal swabs were collected periodically for SARS-COV-2 RNA detection.
Two hundred and seventeen eligible patients (median aged 50 years, 50.2% were females) were analyzed. 21.2% (46/217) of the patients were detected with SARS-CoV-2 RNA in anal swabs. The duration of viral RNA was longer, but the viral load was lower in anal swabs than throat swabs in the early stage of the disease. During a median follow-up of 20 days, 30 (13.8%) patients were admitted to the intensive care unit (ICU) for high-flow nasal cannula or higher-level oxygen support measures to correct hypoxemia. Detectable viral RNA in anal swabs (adjusted hazard ratio [aHR], 2.50; 95% confidence interval [CI], 1.20-5.24), increased C-reactive protein (aHR, 3.14; 95% CI, 1.35-7.32) and lymphocytopenia (aHR, 3.12; 95% CI, 1.46-6.67) were independently associated with ICU admission. The cumulative incidence of ICU admission was higher among patients with detectable viral RNA in anal swabs (26.3% vs 10.7%, P = .006).
Detectable SARS-CoV-2 RNA in the digestive tract was a potential warning indicator of severe disease.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）RNA 已在肠道和粪便中被发现，但它的临床意义尚不完全清楚。我们旨在描述直肠拭子中 SARS-CoV-2 RNA 的纵向检测结果，并探讨其与疾病严重程度的关系。
我们纳入了在广州市第八人民医院住院治疗且经实验室确诊的 2019 冠状病毒病（COVID-19）患者，排除了未接受 SARS-CoV-2 RNA 检测的直肠拭子的患者。我们收集了患者的流行病学、临床和实验室数据。定期采集咽拭子和直肠拭子进行 SARS-CoV-2 RNA 检测。
共纳入 217 例符合条件的患者（中位年龄 50 岁，50.2%为女性）。21.2%（46/217）的患者直肠拭子中检测到 SARS-CoV-2 RNA。疾病早期，直肠拭子中病毒 RNA 持续时间较长，但病毒载量较低。在中位随访 20 天期间，30（13.8%）例患者因低氧血症需要入住重症监护病房（ICU），接受高流量鼻导管或更高水平的氧疗支持措施。直肠拭子中可检测到病毒 RNA（调整后的危险比[aHR]，2.50；95%置信区间[CI]，1.20-5.24）、C 反应蛋白升高（aHR，3.14；95% CI，1.35-7.32）和淋巴细胞减少症（aHR，3.12；95% CI，1.46-6.67）与 ICU 入住相关。直肠拭子中可检测到病毒 RNA 的患者 ICU 入住累积发生率更高（26.3% vs 10.7%，P=0.006）。
消化道中可检测到 SARS-CoV-2 RNA 是疾病严重程度的潜在预警指标。
