Dept of Medicine 5, University Hospital, Ludwig Maximilian University of Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany.
These authors contributed equally to this work.
Eur Respir J. 2021 Jul 20;58(1). doi: 10.1183/13993003.02724-2020. Print 2021 Jul.
A fraction of COVID-19 patients progress to a severe disease manifestation with respiratory failure and the necessity of mechanical ventilation. Identifying patients at risk is critical for optimised care and early therapeutic interventions. We investigated the dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding relative to disease severity.We analysed nasopharyngeal and tracheal shedding of SARS-CoV-2 in 92 patients with diagnosed COVID-19. Upon admission, standardised nasopharyngeal swab or sputum samples were collected. If patients were mechanically ventilated, endotracheal aspirate samples were additionally obtained. Viral shedding was quantified by real-time PCR detection of SARS-CoV-2 RNA.45% (41 out of 92) of COVID-19 patients had a severe disease course with the need for mechanical ventilation (severe group). At week 1, the initial viral shedding determined from nasopharyngeal swabs showed no significant difference between nonsevere and severe cases. At week 2, a difference could be observed as the viral shedding remained elevated in severely ill patients. A time-course of C-reactive protein, interleukin-6 and procalcitonin revealed an even more protracted inflammatory response following the delayed drop of virus shedding load in severely ill patients. A significant proportion (47.8%) of patients showed evidence of prolonged viral shedding (>17 days), which was associated with severe disease courses (73.2%).We report that viral shedding does not differ significantly between severe and nonsevere COVID-19 cases upon admission to the hospital. Elevated SARS-CoV-2 shedding in the second week of hospitalisation, a systemic inflammatory reaction peaking between the second and third week, and prolonged viral shedding are associated with a more severe disease course.
一小部分 COVID-19 患者会发展为严重疾病表现，出现呼吸衰竭和需要机械通气。识别高危患者对于优化护理和早期治疗干预至关重要。我们研究了严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）脱落与疾病严重程度的关系。我们分析了 92 例确诊 COVID-19 患者的鼻咽和气管 SARS-CoV-2 脱落情况。入院时，采集了标准化的鼻咽拭子或痰样。如果患者需要机械通气，则额外采集气管抽吸样本。通过实时 PCR 检测 SARS-CoV-2 RNA 定量病毒脱落。45%（41/92）的 COVID-19 患者病情严重，需要机械通气（严重组）。第 1 周，从鼻咽拭子中确定的初始病毒脱落量在非重症和重症病例之间没有显著差异。第 2 周，由于重症患者的病毒脱落量仍保持升高，因此可以观察到差异。C 反应蛋白、白细胞介素-6 和降钙素原的时间过程表明，在病毒脱落负荷延迟下降后，重症患者的炎症反应更为持久。相当一部分（47.8%）患者出现病毒持续脱落（>17 天）的证据，与严重疾病过程（73.2%）相关。我们报告说，住院时严重和非严重 COVID-19 病例的病毒脱落量没有显著差异。住院第二周 SARS-CoV-2 脱落量增加、第二至第三周全身炎症反应达到高峰以及病毒持续脱落与更严重的疾病过程相关。
