International Journal of Infectious Diseases (Apr 2021)

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

  • Annalisa Mondi,
  • Patrizia Lorenzini,
  • Concetta Castilletti,
  • Roberta Gagliardini,
  • Eleonora Lalle,
  • Angela Corpolongo,
  • Maria Beatrice Valli,
  • Fabrizio Taglietti,
  • Stefania Cicalini,
  • Laura Loiacono,
  • Francesco Di Gennaro,
  • Gianpiero D’Offizi,
  • Fabrizio Palmieri,
  • Emanuele Nicastri,
  • Chiara Agrati,
  • Nicola Petrosillo,
  • Giuseppe Ippolito,
  • Francesco Vaia,
  • Enrico Girardi,
  • Maria Rosaria Capobianchi,
  • Andrea Antinori,
  • Sara Zito,
  • Maria Alessandra Abbonizio,
  • Amina Abdeddaim,
  • Elisabetta Agostini,
  • Chiara Agrati,
  • Fabrizio Albarello,
  • Gioia Amadei,
  • Alessandra Amendola,
  • Andrea Antinori,
  • Maria Assunta Antonica,
  • Mario Antonini,
  • Tommaso Ascoli Bartoli,
  • Francesco Baldini,
  • Raffaella Barbaro,
  • Barbara Bartolini,
  • Rita Bellagamba,
  • Martina Benigni,
  • Nazario Bevilacqua,
  • Gianluigi Biava,
  • Michele Bibas,
  • Licia Bordi,
  • Veronica Bordoni,
  • Evangelo Boumis,
  • Marta Branca,
  • Rosanna Buonomo,
  • Donatella Busso,
  • Marta Camici,
  • Paolo Campioni,
  • Flaminia Canichella,
  • Maria Rosaria Capobianchi,
  • Alessandro Capone,
  • Cinzia Caporale,
  • Emanuela Caraffa,
  • Ilaria Caravella,
  • Fabrizio Carletti,
  • Concetta Castilletti,
  • Adriana Cataldo,
  • Stefano Cerilli,
  • Carlotta Cerva,
  • Roberta Chiappini,
  • Pierangelo Chinello,
  • Maria Assunta Cianfarani,
  • Carmine Ciaralli,
  • Claudia Cimaglia,
  • Nicola Cinicola,
  • Veronica Ciotti,
  • Stefania Cicalini,
  • Francesca Colavita,
  • Angela Corpolongo,
  • Massimo Cristofaro,
  • Salvatore Curiale,
  • Alessandra D’Abramo,
  • Cristina Dantimi,
  • Alessia De Angelis,
  • Giada De Angelis,
  • Maria Grazia De Palo,
  • Federico De Zottis,
  • Virginia Di Bari,
  • Rachele Di Lorenzo,
  • Federica Di Stefano,
  • Gianpiero D’Offizi,
  • Davide Donno,
  • Francesca Evangelista,
  • Francesca Faraglia,
  • Anna Farina,
  • Federica Ferraro,
  • Lorena Fiorentini,
  • Andrea Frustaci,
  • Matteo Fusetti,
  • Vincenzo Galati,
  • Roberta Gagliardini,
  • Paola Gallì,
  • Gabriele Garotto,
  • Ilaria Gaviano,
  • Saba Gebremeskel Tekle,
  • Maria Letizia Giancola,
  • Filippo Giansante,
  • Emanuela Giombini,
  • Guido Granata,
  • Maria Cristina Greci,
  • Elisabetta Grilli,
  • Susanna Grisetti,
  • Gina Gualano,
  • Fabio Iacomi,
  • Marta Iaconi,
  • Giuseppina Iannicelli,
  • Carlo Inversi,
  • Giuseppe Ippolito,
  • Eleonora Lalle,
  • Maria Elena Lamanna,
  • Simone Lanini,
  • Daniele Lapa,
  • Luciana Lepore,
  • Raffaella Libertone,
  • Raffaella Lionetti,
  • Giuseppina Liuzzi,
  • Laura Loiacono,
  • Andrea Lucia,
  • Franco Lufrani,
  • Manuela Macchione,
  • Gaetano Maffongelli,
  • Alessandra Marani,
  • Luisa Marchioni,
  • Andrea Mariano,
  • Maria Cristina Marini,
  • Micaela Maritti,
  • Annelisa Mastrobattista,
  • Ilaria Mastrorosa,
  • Giulia Matusali,
  • Valentina Mazzotta,
  • Paola Mencarini,
  • Silvia Meschi,
  • Francesco Messina,
  • Sibiana Micarelli,
  • Giulia Mogavero,
  • Annalisa Mondi,
  • Marzia Montalbano,
  • Chiara Montaldo,
  • Silvia Mosti,
  • Silvia Murachelli,
  • Maria Musso,
  • Michela Nardi,
  • Assunta Navarra,
  • Emanuele Nicastri,
  • Martina Nocioni,
  • Pasquale Noto,
  • Roberto Noto,
  • Alessandra Oliva,
  • Ilaria Onnis,
  • Sandrine Ottou,
  • Claudia Palazzolo,
  • Emanuele Pallini,
  • Fabrizio Palmieri,
  • Giulio Palombi,
  • Carlo Pareo,
  • Virgilio Passeri,
  • Federico Pelliccioni,
  • Giovanna Penna,
  • Antonella Petrecchia,
  • Ada Petrone,
  • Nicola Petrosillo,
  • Elisa Pianura,
  • Carmela Pinnetti,
  • Maria Pisciotta,
  • Pierluca Piselli,
  • Silvia Pittalis,
  • Agostina Pontarelli,
  • Costanza Proietti,
  • Vincenzo Puro,
  • Paolo Migliorisi Ramazzini,
  • Alessia Rianda,
  • Gabriele Rinonapoli,
  • Silvia Rosati,
  • Dorotea Rubino,
  • Martina Rueca,
  • Alberto Ruggeri,
  • Alessandra Sacchi,
  • Alessandro Sampaolesi,
  • Francesco Sanasi,
  • Carmen Santagata,
  • Alessandra Scarabello,
  • Silvana Scarcia,
  • Vincenzo Schininà,
  • Paola Scognamiglio,
  • Laura Scorzolini,
  • Giulia Stazi,
  • Giacomo Strano,
  • Fabrizio Taglietti,
  • Chiara Taibi,
  • Giorgia Taloni,
  • Tetaj Nardi,
  • Roberto Tonnarini,
  • Simone Topino,
  • Martina Tozzi,
  • Francesco Vaia,
  • Francesco Vairo,
  • Maria Beatrice Valli,
  • Alessandra Vergori,
  • Laura Vincenzi,
  • Ubaldo Visco-Comandini,
  • Serena Vita,
  • Pietro Vittozzi,
  • Mauro Zaccarelli,
  • Antonella Zanetti,
  • Sara Zito,
  • Maria Alessandra Abbonizio,
  • Amina Abdeddaim,
  • Elisabetta Agostini,
  • Chiara Agrati,
  • Fabrizio Albarello,
  • Gioia Amadei,
  • Alessandra Amendola,
  • Andrea Antinori,
  • Maria Assunta Antonica,
  • Mario Antonini,
  • Tommaso Ascoli Bartoli,
  • Francesco Baldini,
  • Raffaella Barbaro,
  • Barbara Bartolini,
  • Rita Bellagamba,
  • Martina Benigni,
  • Nazario Bevilacqua,
  • Gianluigi Biava,
  • Michele Bibas,
  • Licia Bordi,
  • Veronica Bordoni,
  • Evangelo Boumis,
  • Marta Branca,
  • Rosanna Buonomo,
  • Donatella Busso,
  • Marta Camici,
  • Paolo Campioni,
  • Flaminia Canichella,
  • Maria Rosaria Capobianchi,
  • Alessandro Capone,
  • Cinzia Caporale,
  • Emanuela Caraffa,
  • Ilaria Caravella,
  • Fabrizio Carletti,
  • Concetta Castilletti,
  • Adriana Cataldo,
  • Stefano Cerilli,
  • Carlotta Cerva,
  • Roberta Chiappini,
  • Pierangelo Chinello,
  • Maria Assunta Cianfarani,
  • Carmine Ciaralli,
  • Claudia Cimaglia,
  • Nicola Cinicola,
  • Veronica Ciotti,
  • Stefania Cicalini,
  • Francesca Colavita,
  • Angela Corpolongo,
  • Massimo Cristofaro,
  • Salvatore Curiale,
  • Alessandra D’Abramo,
  • Cristina Dantimi,
  • Alessia De Angelis,
  • Giada De Angelis,
  • Maria Grazia De Palo,
  • Federico De Zottis,
  • Virginia Di Bari,
  • Rachele Di Lorenzo,
  • Federica Di Stefano,
  • Gianpiero D’Offizi,
  • Davide Donno,
  • Francesca Evangelista,
  • Francesca Faraglia,
  • Anna Farina,
  • Federica Ferraro,
  • Lorena Fiorentini,
  • Andrea Frustaci,
  • Matteo Fusetti,
  • Vincenzo Galati,
  • Roberta Gagliardini,
  • Paola Gallì,
  • Gabriele Garotto,
  • Ilaria Gaviano,
  • Saba Gebremeskel Tekle,
  • Maria Letizia Giancola,
  • Filippo Giansante,
  • Emanuela Giombini,
  • Guido Granata,
  • Maria Cristina Greci,
  • Elisabetta Grilli,
  • Susanna Grisetti,
  • Gina Gualano,
  • Fabio Iacomi,
  • Marta Iaconi,
  • Giuseppina Iannicelli,
  • Carlo Inversi,
  • Giuseppe Ippolito,
  • Eleonora Lalle,
  • Maria Elena Lamanna,
  • Simone Lanini,
  • Daniele Lapa,
  • Luciana Lepore,
  • Raffaella Libertone,
  • Raffaella Lionetti,
  • Giuseppina Liuzzi,
  • Laura Loiacono,
  • Andrea Lucia,
  • Franco Lufrani,
  • Manuela Macchione,
  • Gaetano Maffongelli,
  • Alessandra Marani,
  • Luisa Marchioni,
  • Andrea Mariano,
  • Maria Cristina Marini,
  • Micaela Maritti,
  • Annelisa Mastrobattista,
  • Ilaria Mastrorosa,
  • Giulia Matusali,
  • Valentina Mazzotta,
  • Paola Mencarini,
  • Silvia Meschi,
  • Francesco Messina,
  • Sibiana Micarelli,
  • Giulia Mogavero,
  • Annalisa Mondi,
  • Marzia Montalbano,
  • Chiara Montaldo,
  • Silvia Mosti,
  • Silvia Murachelli,
  • Maria Musso,
  • Michela Nardi,
  • Assunta Navarra,
  • Emanuele Nicastri,
  • Martina Nocioni,
  • Pasquale Noto,
  • Roberto Noto,
  • Alessandra Oliva,
  • Ilaria Onnis,
  • Sandrine Ottou,
  • Claudia Palazzolo,
  • Emanuele Pallini,
  • Fabrizio Palmieri,
  • Giulio Palombi,
  • Carlo Pareo,
  • Virgilio Passeri,
  • Federico Pelliccioni,
  • Giovanna Penna,
  • Antonella Petrecchia,
  • Ada Petrone,
  • Nicola Petrosillo,
  • Elisa Pianura,
  • Carmela Pinnetti,
  • Maria Pisciotta,
  • Pierluca Piselli,
  • Silvia Pittalis,
  • Agostina Pontarelli,
  • Costanza Proietti,
  • Vincenzo Puro,
  • Paolo Migliorisi Ramazzini,
  • Alessia Rianda,
  • Gabriele Rinonapoli,
  • Silvia Rosati,
  • Dorotea Rubino,
  • Martina Rueca,
  • Alberto Ruggeri,
  • Alessandra Sacchi,
  • Alessandro Sampaolesi,
  • Francesco Sanasi,
  • Carmen Santagata,
  • Alessandra Scarabello,
  • Silvana Scarcia,
  • Vincenzo Schininà,
  • Paola Scognamiglio,
  • Laura Scorzolini,
  • Giulia Stazi,
  • Giacomo Strano,
  • Fabrizio Taglietti,
  • Chiara Taibi,
  • Giorgia Taloni,
  • Tetaj Nardi,
  • Roberto Tonnarini,
  • Simone Topino,
  • Martina Tozzi,
  • Francesco Vaia,
  • Francesco Vairo,
  • Maria Beatrice Valli,
  • Alessandra Vergori,
  • Laura Vincenzi,
  • Ubaldo Visco-Comandini,
  • Serena Vita,
  • Pietro Vittozzi,
  • Mauro Zaccarelli,
  • Antonella Zanetti,
  • Sara Zito

Journal volume & issue
Vol. 105
pp. 532 – 539

Abstract

Read online

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.

Keywords