Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2020; 8(24): 6252-6263
Published online Dec 26, 2020. doi: 10.12998/wjcc.v8.i24.6252
Virus load and virus shedding of SARS-CoV-2 and their impact on patient outcomes
Pei-Fen Chen, Xia-Xia Yu, Yi-Peng Liu, Di Ren, Min Shen, Bing-Sheng Huang, Jun-Ling Gao, Zheng-Yang Huang, Ming Wu, Wei-Yan Wang, Li Chen, Xia Shi, Zhao-Qing Wang, Ying-Xia Liu, Lei Liu, Yong Liu
Pei-Fen Chen, Yi-Peng Liu, Department of Respiratory Diseases, Shenzhen Key Laboratory of Pathogen and Immunity, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Diseases, Shenzhen Third People’s Hospital, The Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen 518114, Guangdong Province, China
Pei-Fen Chen, Department of Infectious Diseases, Linzhi People’s Hospital, Linzhi 860000, Tibet Autonomous Region, China
Xia-Xia Yu, Zheng-Yang Huang, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, Guangdong Province, China
Di Ren, Expert Panel of Shenzhen 2019-nCoV Pneumonia, The Second People’s Hospital of Shenzhen, Shenzhen 518035, Guangdong Province, China
Min Shen, Wei-Yan Wang, Li Chen, Xia Shi, Zhao-Qing Wang, Ying-Xia Liu, Lei Liu, Shenzhen Key Laboratory of Pathogen and Immunity, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Diseases, Shenzhen Third People’s Hospital, The Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen 518114, Guangdong Province, China
Bing-Sheng Huang, Medical AI Laboratory, School of Biomedical Engineering, Health Science Centre, Shenzhen University, Shenzhen 518060, Guangdong Province, China
Jun-Ling Gao, Buddhism and Science Research Laboratory, Centre of Buddhist Studies, The University of Hong Kong, Pokfulam, Hong Kong 999077, China
Ming Wu, ICU, The Second People's Hospital of Shenzhen, Shenzhen 518035, Guangdong Province, China
Yong Liu, Expert Panel of Shenzhen 2019-nCoV Pneumonia, Shenzhen Hospital, Southern Medical University, Shenzhen 518000, Guangdong Province, China
Author contributions: Liu Y and Liu L designed and coordinated this study; Chen PF, Liu Y, and Ren D contributed to data collection and management; Liu Y, Yu XX, Gao JL, Huang ZY and Huang BS contributed to data analysis and draft writing; Liu L and Huang BS contributed to the final approval of the version to be submitted; and all authors read and approved the final manuscript.
Supported by Startup Fund for Youth Faculty of Shenzhen University, No. 2018009.
Institutional review board statement: This retrospective study was approved by the institutional review board of Shenzhen Third People’s Hospital.
Informed consent statement: Informed written consent was obtained from all subjects prior to the study.
Conflict-of-interest statement: The authors declared no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong Liu, MD, Chief Doctor, Expert Panel of Shenzhen 2019-nCoV Pneumonia, Shenzhen Hospital, Southern Medical University, No. 1333 Xinhu Road, Baoan District, Shenzhen 518000, Guangdong Province, China. liuyongjoy@outlook.com
Received: August 31, 2020
Peer-review started: August 31, 2020
First decision: September 24, 2020
Revised: October 1, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: December 26, 2020
Abstract
BACKGROUND

Understanding a virus shedding patterns in body fluids/secretions is important to determine the samples to be used for diagnosis and to formulate infection control measures.

AIM

To investigate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding patterns and its risk factors.

METHODS

All laboratory-confirmed coronavirus disease 2019 patients with complete medical records admitted to the Shenzhen Third People’s Hospital from January 28, 2020 to March 8, 2020 were included. Among 145 patients (54.5% males; median age, 46.1 years), three (2.1%) died. The bronco-alveolar lavage fluid (BALF) had the highest virus load compared with the other samples. The viral load peaked at admission (3.3 × 108 copies) and sharply decreased 10 d after admission.

RESULTS

The viral load was associated with prolonged intensive care unit (ICU) duration. Patients in the ICU had significantly longer shedding time compared to those in the wards (P < 0.0001). Age > 60 years [hazard ratio (HR) = 0.6; 95% confidence interval (CI): 0.4-0.9] was an independent risk factor for SARS-CoV-2 shedding, while chloroquine (HR = 22.8; 95%CI: 2.3-224.6) was a protective factor.

CONCLUSION

BALF had the highest SARS-CoV-2 load. Elderly patients had higher virus loads, which was associated with a prolonged ICU stay. Chloroquine was associated with shorter shedding duration and increased the chance of viral negativity.

Keywords: COVID-19, Virus shedding, Viral load, Patient outcome, China, Infectious disease

Core Tip: Severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV-2) can be found in various samples, including eye discharge. The virus load increased sharply at admission and dropped dramatically thereafter. Later admission was associated with longer virus shedding, higher ICU admission and lower survival probability. As for clinical treatment, we found that chloroquine could potentially increase the chance of viral shedding.