Zhao Hong, Tu Huilan, Yu Xia, Su Junwei, Zhang Xuan, Xu Kaijin, Shi Yu, Qiu Yunqing, Sheng Jifang
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China.
Infect Drug Resist. 2022 Apr 20;15:1971-1979. doi: 10.2147/IDR.S353688. eCollection 2022.
To analyze the possible risk factors of delayed virus clearance in hospitalized patients with coronavirus disease 2019 (COVID-19).
Retrospective analysis of patients with COVID-19 admitted to the isolation wards from our hospital from 19th Jan 2020 to 18th March 2020. We were collected patient's data including demographic, epidemiologic, and clinical information, as well as laboratory and radiologic findings. The possible confounding risk factors for prolonged viral RNA shedding of COVID-19 during hospitalization were explored by univariate analysis and any variables with a p value less than 0.05 after univariate analysis were included in a subsequent multivariate logistic regression model analysis.
The 104 patients included 30 mild patients and 74 severe or critically ill patients. The median duration of viral RNA positivity in sputum was 11 days, and the longest duration of viral RNA positivity was 49 days after admission. Multivariate analysis shown that the used with darunavir/cobicistat treatment (odds ratio [OR]: 4.25, 95% confidence interval [CI]: 1.25-14.42, p = 0.020), duration of fever (OR: 1.15, 95% CI: 1.03-1.30, p = 0.015) and time to radiological improvement (OR: 1.14, 95% CI: 1.01-1.30, p = 0.033) were associated with delayed clearance of SARS-CoV-2 in sputum from COVID-19 patients. Then adjusted in the multivariate binary logistic regression analysis model in severe COVID-19 and found that critical COVID-19 patients (OR: 13.25, 95% CI: 1.45-12.07, p = 0.022), lower virus cycle threshold (CT) values of RT-PCR (OR: 0.96, 95% CI: 0.93-0.99, p = 0.004) and used with darunavir/cobicistat treatment (OR: 8.44, 95% CI: 2.21-32.28, p = 0.022) were associated with delayed clearance of SARS-CoV-2 in sputum from COVID-19 patients.
Clearance of viral RNA in sputum was delayed in severe COVID-19 patients, especially with lower virus CT value. And antivirals with darunavir/cobicistat has little advantage in eliminating SARS-CoV-2.
分析2019冠状病毒病（COVID-19）住院患者病毒清除延迟的可能危险因素。
回顾性分析2020年1月19日至2020年3月18日我院隔离病房收治的COVID-19患者。收集患者的人口统计学、流行病学和临床信息，以及实验室和影像学检查结果。通过单因素分析探讨COVID-19住院期间病毒RNA长时间脱落的可能混杂危险因素，单因素分析后p值小于0.05的任何变量纳入后续多因素逻辑回归模型分析。
104例患者中，轻症患者30例，重症或危重症患者74例。痰中病毒RNA阳性的中位持续时间为11天，入院后病毒RNA阳性的最长持续时间为49天。多因素分析显示，使用达芦那韦/考比司他治疗（比值比[OR]：4.25，95%置信区间[CI]：1.25-14.42，p = 0.020）、发热持续时间（OR：1.15，95% CI：1.03-1.30，p = 0.015）和影像学改善时间（OR：1.14，95% CI：1.01-1.30，p = 0.033）与COVID-19患者痰中SARS-CoV-2清除延迟有关。在重症COVID-19的多因素二元逻辑回归分析模型中进行校正后发现，危重症COVID-19患者（OR：13.25，95% CI：1.45-12.07，p = 0.022）、逆转录聚合酶链反应（RT-PCR）的病毒循环阈值（CT）值较低（OR：0.96，95% CI：0.93-0.99，p = 0.004）和使用达芦那韦/考比司他治疗（OR：8.44，95% CI：2.21-32.28，p = 0.022）与COVID-19患者痰中SARS-CoV-2清除延迟有关。
重症COVID-19患者痰中病毒RNA清除延迟，尤其是病毒CT值较低者。达芦那韦/考比司他等抗病毒药物在清除SARS-CoV-2方面优势不大。
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