TY - JOUR
T1 - Risk and predictive factors of prolonged viral RNA shedding in upper respiratory specimens in a large cohort of COVID-19 patients admitted to an Italian reference hospital
AU - Mondi, Annalisa
AU - Lorenzini, Patrizia
AU - Castilletti, Concetta
AU - Gagliardini, Roberta
AU - Lalle, Eleonora
AU - Corpolongo, Angela
AU - Valli, Maria Beatrice
AU - Taglietti, Fabrizio
AU - Cicalini, Stefania
AU - Loiacono, Laura
AU - D'Offizi, Gianpiero
AU - Palmieri, Fabrizio
AU - Nicastri, Emanuele
AU - Agrati, Chiara
AU - Petrosillo, Nicola
AU - Ippolito, Giuseppe
AU - Vaia, Francesco
AU - Girardi, Enrico
AU - Capobianchi, Maria Rosaria
AU - Antinori, Andrea
AU - For the INMI Recovery study group
AU - Abdeddaim, Amina
AU - Albarello, Fabrizio
AU - Amendola, Alessandra
AU - Antonini, Mario
AU - Bartoli, Tommaso Ascoli
AU - Baldini, Francesco
AU - Barbaro, Raffaella
AU - Bartolini, Barbara
AU - Bellagamba, Rita
AU - Bevilacqua, Nazario
AU - Biava, Gianluigi
AU - Bibas, Michele
AU - Bordi, Licia
AU - Bordoni, Veronica
AU - Boumis, Evangelo
AU - Busso, Donatella
AU - Camici, Marta
AU - Campioni, Paolo
AU - Capone, Alessandro
AU - Caraffa, Emanuela
AU - Caravella, Ilaria
AU - Carletti, Fabrizio
AU - Cerilli, Stefano
AU - Chiappini, Roberta
AU - Chinello, Pierangelo
AU - Ciaralli, Carmine
AU - Cimaglia, Claudia
AU - Colavita, Francesca
AU - Cristofaro, Massimo
AU - Curiale, Salvatore
AU - D'Abramo, Alessandra
AU - Dantimi, Cristina
AU - De Angelis, Alessia
AU - De Angelis, Giada
AU - De Zottis, Federico
AU - Di Bari, Virginia
AU - Di Lorenzo, Rachele
AU - Di Stefano, Federica
AU - Faraglia, Francesca
AU - Ferraro, Federica
AU - Frustaci, Andrea
AU - Fusetti, Matteo
AU - Galati, Vincenzo
AU - Gallì, Paola
AU - Garotto, Gabriele
AU - Tekle, Saba Gebremeskel
AU - Giancola, Maria Letizia
AU - Giansante, Filippo
AU - Giombini, Emanuela
AU - Granata, Guido
AU - Greci, Maria Cristina
AU - Grilli, Elisabetta
AU - Grisetti, Susanna
AU - Gualano, Gina
AU - Iacomi, Fabio
AU - Iannicelli, Giuseppina
AU - Lanini, Simone
AU - Lapa, Daniele
AU - Lepore, Luciana
AU - Libertone, Raffaella
AU - Lionetti, Raffaella
AU - Liuzzi, Giuseppina
AU - Macchione, Manuela
AU - Maffongelli, Gaetano
AU - Marani, Alessandra
AU - Marchioni, Luisa
AU - Mariano, Andrea
AU - Marini, Maria Cristina
AU - Maritti, Micaela
AU - Mastrorosa, Ilaria
AU - Matusali, Giulia
AU - Mazzotta, Valentina
AU - Mencarini, Paola
AU - Meschi, Silvia
AU - Messina, Francesco
AU - Montalbano, Marzia
AU - Montaldo, Chiara
AU - Mosti, Silvia
AU - Murachelli, Silvia
AU - Musso, Maria
AU - Navarra, Assunta
AU - Noto, Pasquale
AU - Oliva, Alessandra
AU - Ottou, Sandrine
AU - Palazzolo, Claudia
AU - Pareo, Carlo
AU - Petrecchia, Antonella
AU - Petrone, Ada
AU - Pianura, Elisa
AU - Pinnetti, Carmela
AU - Piselli, Pierluca
AU - Pittalis, Silvia
AU - Puro, Vincenzo
AU - Ramazzini, Paolo Migliorisi
AU - Rianda, Alessia
AU - Rosati, Silvia
AU - Rueca, Martina
AU - Sacchi, Alessandra
AU - Sampaolesi, Alessandro
AU - Santagata, Carmen
AU - Scarabello, Alessandra
AU - Schininà, Vincenzo
AU - Scognamiglio, Paola
AU - Scorzolini, Laura
AU - Stazi, Giulia
AU - Taibi, Chiara
AU - Tonnarini, Roberto
AU - Topino, Simone
AU - Vairo, Francesco
AU - Vergori, Alessandra
AU - Vincenzi, Laura
AU - Visco-Comandini, Ubaldo
AU - Vita, Serena
AU - Vittozzi, Pietro
AU - Zaccarelli, Mauro
N1 - Funding Information:
This work was supported by Line one - Ricerca Corrente ‘Infezioni Emergenti e Riemergenti’ and by Progetto COVID 2020 12,371,675 both funded by Italian Ministry of Health .
Publisher Copyright:
© 2021 The Authors
PY - 2021/4
Y1 - 2021/4
N2 - Background: Limited data are available about the predictors and outcomes associated with prolonged SARS-CoV-2 RNA shedding (VS). Methods: A retrospective study including COVID-19 patients admitted to an Italian hospital between March 1 and July 1, 2020. Predictors of viral clearance (VC) and prolonged VS from the upper respiratory tract were assessed by Poisson regression and logistic regression analyses. The causal relation between VS and clinical outcomes was evaluated through an inverse probability weighted Cox model. Results: The study included 536 subjects. The median duration of VS from symptoms onset was 18 days. The estimated 30-day probability of VC was 70.2%. Patients with comorbidities, lymphopenia at hospital admission, or moderate/severe respiratory disease had a lower chance of VC. The development of moderate/severe respiratory failure, delayed hospital admission after symptoms onset, baseline comorbidities, or D-dimer >1000 ng/mL at admission independently predicted prolonged VS. The achievement of VC doubled the chance of clinical recovery and reduced the probability of death/mechanical ventilation. Conclusions: Respiratory disease severity, comorbidities, delayed hospital admission and inflammatory markers negatively predicted VC, which resulted to be associated with better clinical outcomes. These findings highlight the importance of prompt hospitalization of symptomatic patients, especially where signs of severity or comorbidities are present.
AB - Background: Limited data are available about the predictors and outcomes associated with prolonged SARS-CoV-2 RNA shedding (VS). Methods: A retrospective study including COVID-19 patients admitted to an Italian hospital between March 1 and July 1, 2020. Predictors of viral clearance (VC) and prolonged VS from the upper respiratory tract were assessed by Poisson regression and logistic regression analyses. The causal relation between VS and clinical outcomes was evaluated through an inverse probability weighted Cox model. Results: The study included 536 subjects. The median duration of VS from symptoms onset was 18 days. The estimated 30-day probability of VC was 70.2%. Patients with comorbidities, lymphopenia at hospital admission, or moderate/severe respiratory disease had a lower chance of VC. The development of moderate/severe respiratory failure, delayed hospital admission after symptoms onset, baseline comorbidities, or D-dimer >1000 ng/mL at admission independently predicted prolonged VS. The achievement of VC doubled the chance of clinical recovery and reduced the probability of death/mechanical ventilation. Conclusions: Respiratory disease severity, comorbidities, delayed hospital admission and inflammatory markers negatively predicted VC, which resulted to be associated with better clinical outcomes. These findings highlight the importance of prompt hospitalization of symptomatic patients, especially where signs of severity or comorbidities are present.
KW - Coronavirus
KW - COVID-19, viral clearance, viral shedding
KW - Risk factors
KW - SARS-CoV-2
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U2 - 10.1016/j.ijid.2021.02.117
DO - 10.1016/j.ijid.2021.02.117
M3 - Article
C2 - 33676001
AN - SCOPUS:85102838723
VL - 105
SP - 532
EP - 539
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
SN - 1201-9712
ER -