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
ARTICLE HIGHLIGHTS
Research background

The outbreak of coronavirus disease 2019 (COVID-19) cause emotional distress and anxiety worldwide. However, the factors for the severity of illness and its outcomes still remain unclear.

Research motivation

The goal of this study was to characterize the viral shedding patterns and risk factors in hospitalized patients with COVID-19.

Research objectives

The study aimed to identify the characteristics of viral load and shedding, the risk factors affecting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus clearance and to evaluate the effect of prolonged viral shedding on the outcome of the patients.

Research methods

This was a retrospective study on all laboratory-confirmed COVID-19 patients with complete medical records admitted to the Shenzhen Third People’s Hospital from January 1, 2020 to March 8, 2020. A total of 7404 virological tests in 1350 patients were analyzed to identify the pattern of virus load in different samples. Furthermore, 145 patients with full inpatient records were statistically analyzed to reveal the risk factors associated with the viral shedding and ICU admission by multivariate cox regression.

Research results

SARS-CoV-2 virus was identified in a wide range of samples, including eye discharge. Earlier hospitalization might help reduce the virus-shedding period and intensive care unit (ICU) stay. Chloroquine is associated with the shortened shedding duration.

Research conclusions

Among various samples the SARS-CoV-2 virus, bronchoalveolar lavage fluid 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 a shorter shedding duration and increased the chance of viral negativity.

Research perspectives

The findings about the virus shedding patterns and its risk factors suggested that early hospitalization has the potential to reduce the virus shedding time and the ICU stay. Also, the confirmation of effectiveness of immunomodulation and chloroquine might help in clinical treatment and policy making.