Associations of clinical characteristics and antiviral drugs with viral RNA clearance in patients with COVID-19 in Guangzhou, China: a retrospective cohort study

  1. Xudan Chen
  2. Yuying Zhang
  3. Baoyi Zhu
  4. Jianwen Zeng
  5. Wenxin Hong
  6. Xi He
  7. Jingfeng Chen
  8. Haipeng Zheng
  9. Shuang Qiu
  10. Ying Deng
  11. Juliana CN Chan
  12. Jian Wang

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Abstract

Background

The novel coronavirus disease 2019 (COVID-19) characterized by respiratory symptoms has become a global pandemic although factors influencing viral RNA clearance remained unclear to inform optimal isolation period and treatment strategies.

Methods

In this retrospective study, we included patients with confirmed COVID-19 admitted to Guangzhou Eighth People’s Hospital from 20 th January 2020 to 15 th March 2020. The associations of clinical characteristics and treatment regimens on time to viral RNA clearance were analyzed.

Results

We examined 284 consecutive COVID-19 cases, accounting for 82% of confirmed cases in Guangzhou during this period. At the time of reporting (20 th March 2020), 276 (97.2%) had recovered and were discharged from hospital with a median hospital stay of 18 days (interquartile range [IQR]:13-24). Overall, 280 patients achieved viral RNA clearance with a median length of 12 days (IQR: 8-16) after onset of illness. Amongst them, 66.1% had viral RNA cleared within 14 days, and 89.3% within 21 days. Older age, severity of disease, time lag from illness onset to hospital admission, high body temperature, and corticosteroid use were associated with delayed clearance of viral RNA. None of the antiviral regimens (chloroquine, oseltamivir, arbidol, and lopinavir/ritonavir) improved viral RNA clearance. The use of lopinavir/ritonavir was associated with delayed clearance of viral RNA after adjusting for confounders.

Conclusion

In patients with COVID-19, isolation for a minimum of 21 days after onset of illness may be warranted, while the use of antiviral drugs does not enhance viral RNA clearance.

Brief Summary

Viral RNA was cleared in 89% of the COVID-19 patients within 21 days after illness onset. The use of antiviral drugs (chloroquine, oseltamivir, arbidol, and lopinavir/ritonavir) did not shorten viral RNA clearance, especially in non-serious cases.

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  1. ScreenIT

    SciScore for 10.1101/2020.04.09.20058941: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the ethics committee of the Eighth Hospital of Guangzhou and all patients gave written informed consent.
    Consent: The study was approved by the ethics committee of the Eighth Hospital of Guangzhou and all patients gave written informed consent.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis: Statistical analysis was performed using the IBM SPSS Statistics 20.0.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There were some limitations in this study. First, due to small sample size, our data regarding treatment efficacy of antiviral drugs should be interpreted with caution. Second, our patients had predominately mild to moderate illness and the results may not apply to those with serious or critical illness. Third, the RT-PCR test used to detect viral nuclear acid in this study may not be sensitive enough to detect samples with low viral load with possible false-negative results. Fourth, the viral RNA test was repeated every 2-3 days after hospitalization, therefore the time to viral RNA clearance may have a little bias. Lastly, it is a retrospective single-center study, and large-scale prospective studies are needed to confirm these findings. In conclusion, in patients with COVID-19, a minimum of 21 days’ isolation since illness onset may be warranted even for asymptomatic patients. Old people are more likely to have serious illness with delayed clearance of viral RNA, and may require prolonged period of support and isolation. The use of antiviral drugs (chloroquine, oseltamivir, arbidol, and lopinavir/ritonavir) did not improve viral RNA clearance, while corticosteroid use was associated with delayed clearance of viral RNA and should be used with caution.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.04.09.20058941v1 on medRxiv