Factors associated with negative conversion of viral RNA in patients hospitalized with COVID-19

Sci Total Environ. 2020 Aug 1:728:138812. doi: 10.1016/j.scitotenv.2020.138812. Epub 2020 Apr 22.

Abstract

Factors associated with negative conversion of SARS-CoV-2 RNA in hospitalized patients have not yet been systematically determined. We conducted a retrospective cohort study of COVID-19 patients in Qingdao, China. Both univariate and multivariate analysis were performed to identify independent factors for time to viral RNA negative conversion. Data on patients with re-detectable viral RNA after showing negative on RT-PCR test (intermittent negative status) were also analyzed. A total of 59 patients confirmed with COVID-19 were included in this study, with a median duration of 1 (interquartile range, IQR: 0-2) day from symptom onset to hospital admission. Median communicable period (from first day of positive nucleic acid test to first day of consecutive negative results) was 14 (IQR: 10-18) days, and 7 (IQR: 6-10) days for 10 patients with intermittent negative results. Age older than 45 years (hazard ratio, HR: 0.378; 95% confidence interval, CI: 0.205-0.698) and chest tightness (HR: 0.290; 95%CI: 0.091-0.919) were factors independently affecting negative conversion of SARS-CoV-2 RNA. Headache (odds ratio: 7.553; 95%CI: 1.011-28.253) was significantly associated with intermittent negative status, with a predicted probability of 60%. Older age and chest tightness were independently associated with delayed clearance of SARS-CoV-2 RNA in hospitalized patients. These predictors would provide a new perspective on early identification of patients with prolonged viral shedding and facilitate optimal isolation protocols and treatment strategies.

Keywords: Coronavirus disease 2019 (COVID-19); Hazard ratio; Negative conversion; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

MeSH terms

  • Adult
  • Age Factors*
  • Betacoronavirus
  • COVID-19
  • COVID-19 Testing
  • China
  • Clinical Laboratory Techniques
  • Coronavirus Infections / diagnosis*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / diagnosis*
  • RNA, Viral / isolation & purification*
  • Retrospective Studies
  • SARS-CoV-2
  • Virus Shedding

Substances

  • RNA, Viral