From the, Covid19 Department, Clinica, Pamplona, Spain.
Pulmonary Medicine Department, Clinica, Pamplona, Spain.
J Intern Med. 2021 Jun;289(6):921-925. doi: 10.1111/joim.13237. Epub 2021 Feb 9.
SARS-CoV-2, the COVID-19 causative agent, has infected millions of people and killed over 1.6 million worldwide. A small percentage of cases persist with prolonged positive RT-PCR on nasopharyngeal swabs. The aim of this study was to determine risk factors for prolonged viral shedding amongst patient's basal clinical conditions.
We have evaluated all 513 patients attended in our hospital between 1 March and 1 July. We have selected all 18 patients with prolonged viral shedding and compared them with 36 sex-matched randomly selected controls. Demographic, treatment and clinical data were systematically collected.
Global median duration of viral clearance was 25.5 days (n = 54; IQR, 22-39.3 days), 48.5 days in cases (IQR 38.7-54.9 days) and 23 days in controls (IQR 20.2-25.7), respectively. There were not observed differences in demographic, symptoms or treatment data between groups. Chronic rhinosinusitis and atopy were more common in patients with prolonged viral shedding (67%) compared with controls (11% and 25% respectively) (P < 0.001 and P = 0.003). The use of inhaled corticosteroids was also more frequent in case group (P = 0.007). Multivariate analysis indicated that CRS (odds ratio [OR], 18.78; 95% confidence interval [95%CI], 3.89-90.59; P < 0.001) was independently associated with prolonged SARS-CoV-2 RNA shedding in URT samples, after adjusting for initial PCR Ct values.
We found that chronic rhinosinusitis and atopy might be associated with increased risk of prolonged viral shedding. If confirmed in prospective trials, this finding might have clinical implications for quarantine duration due to increased risk of pandemic spread.
导致 COVID-19 的 SARS-CoV-2 已感染数百万人，并导致全球超过 160 万人死亡。一小部分病例的鼻咽拭子 RT-PCR 持续呈阳性。本研究旨在确定患者基础临床状况与延长病毒脱落之间的关系。
我们评估了 2020 年 3 月 1 日至 7 月 1 日期间在我院就诊的 513 名患者。选择了所有 18 名病毒持续脱落的患者，并与 36 名随机性别匹配的对照进行比较。系统收集了人口统计学、治疗和临床数据。
全球病毒清除中位时间为 25.5 天（n=54；IQR，22-39.3 天），病例组为 48.5 天（IQR 38.7-54.9 天），对照组为 23 天（IQR 20.2-25.7 天）。两组在人口统计学、症状或治疗数据方面无差异。与对照组（11%和 25%）相比，持续性病毒脱落患者中慢性鼻-鼻窦炎和过敏更为常见（67%）（P<0.001 和 P=0.003）。病例组使用吸入皮质激素也更为频繁（P=0.007）。多变量分析表明，在调整初始 PCR Ct 值后，CRS（比值比[OR]，18.78；95%置信区间[95%CI]，3.89-90.59；P<0.001）与 URT 样本中 SARS-CoV-2 RNA 持续脱落独立相关。
我们发现慢性鼻-鼻窦炎和过敏可能与延长病毒脱落的风险增加有关。如果在前瞻性试验中得到证实，这一发现可能对隔离时间有临床意义，因为这会增加大流行传播的风险。
