Intensive Care Unit, The Fifth People's Hospital of Suzhou, 10 Guangqian Road, Suzhou, 215000, China.
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, China.
Respir Med. 2021 Mar;178:106328. doi: 10.1016/j.rmed.2021.106328. Epub 2021 Feb 6.
The outbreak of COVID-19 has caused ever-increasing attention and public panic all over the world. Until now, data are limited about the risk factors to virus shedding in COVID-19 infected patients.
In this retrospective study, data were collected from 87 patients hospitalized with COVID-19 infection in Suzhou. Using Cox proportional hazards regression and Kaplan-Meier survival analysis, the risk factors to COVID-19 RNA shedding was to be established according to demographic information, clinical characteristics, epidemiological history, antiviral medicine and corticosteroid administration.
The median duration of COVID-19 RNA shedding from admission was 13.11 ± 0.76 days. There was no significant difference in viral shedding duration in terms of gender, age, history of Hubei province stay, characteristics of chest CT on admission, lymphocytopenia and clinical severity. By Cox proportional hazards model, excessive 200 mg cumulative corticosteroid (HR, 3.425 [95% CI, 1.339-7.143]), time from illness onset to hospitalization (<5 days) (HR, 2.503 [95% CI, 1.433-4.371]) and arbidol-included therapy (HR, 2.073 [95% CI, 1.185-3.626]) were the independent risk factors to delay COVID-19 RNA shedding. Besides of excessive 200 mg of cumulative corticosteroid (HR, 2.825 [95% CI, 1.201-6.649]), admission within 5 days from illness onset (HR, 2.493 [95% CI, 1.393-4.462]) and arbidol-included therapy (HR, 2.102 [95% CI, 1.073-4.120]), lymphocytopenia (HR, 2.153 [95% CI, 1.097-4.225]) was further identified as another unfavorable factor to 10-day viral shedding.
The potential risk factors could help clinicians to identify patients with delayed viral shedding, thereby providing the rational strategy of treatment and optimal anti-viral interventions.
COVID-19 的爆发引起了全球对病毒传播风险因素的日益关注和公众恐慌。截至目前，有关 COVID-19 感染患者病毒脱落风险因素的数据有限。
本回顾性研究收集了苏州 87 例 COVID-19 感染住院患者的数据。采用 Cox 比例风险回归和 Kaplan-Meier 生存分析，根据人口统计学信息、临床特征、流行病学史、抗病毒药物和皮质类固醇的使用情况，确定 COVID-19 RNA 脱落的风险因素。
从入院到 COVID-19 RNA 脱落的中位持续时间为 13.11±0.76 天。在性别、年龄、湖北省逗留史、入院时胸部 CT 特征、淋巴细胞减少症和临床严重程度方面，病毒脱落持续时间无显著差异。通过 Cox 比例风险模型，累积使用 200mg 以上皮质类固醇（HR，3.425[95%CI，1.339-7.143]）、从发病到住院时间（HR，2.503[95%CI，1.433-4.371]）和利巴韦林治疗（HR，2.073[95%CI，1.185-3.626]）是延迟 COVID-19 RNA 脱落的独立危险因素。除了累积使用 200mg 以上皮质类固醇（HR，2.825[95%CI，1.201-6.649]）、发病后 5 天内住院（HR，2.493[95%CI，1.393-4.462]）和利巴韦林治疗（HR，2.102[95%CI，1.073-4.120]）外，淋巴细胞减少症（HR，2.153[95%CI，1.097-4.225]）也是 10 天病毒脱落的不利因素。
这些潜在的危险因素有助于临床医生识别病毒脱落延迟的患者，从而提供合理的治疗策略和最佳的抗病毒干预措施。
