Clinical characteristics of Covid-19 patients with re-positive test results: an observational study

  1. Ying Su
  2. Ling-Shuang Zhu
  3. Yong Gao
  4. Yuncheng Li
  5. Zhanlu Xiong
  6. Bo Hu
  7. Jiao Yuan
  8. Zhao Zhang
  9. Xiaoxiong Wu
  10. Chunchen Feng
  11. Fanjun Cheng
  12. Yang Jin
  13. Yu Zhang
  14. Youming Lu
  15. Hongbo Wang
  16. Ling-Qiang Zhu

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Abstract

Background

With coronavirus disease 2019 (Covid-19) ravaging the global, concern has been aroused whether discharged Covid-19 patients with reappeared positive nucleic acid test results are infected again.

Objective

To analyze the clinical characteristics of discharged Covid-19 patients with reappeared positive nucleic acid test results and to track clinical outcomes of them.

Methods

We extracted clinical data on 938 Covid-19 patients from Wuhan Union Hospital (West Branch), and we obtained information about residual symptoms and nucleic acid tests after discharge through follow-up study. We evaluated the relationship of clinical characteristics and reappeared positive results. Each patient had at least 44 days of follow-up.

Results

Of 938 discharged patients, a total of 58 (6.2%) had reappeared positive nucleic acid test results and 880 remain negative. Among patients over the age of 50, the factors we found to be associated with re-positive results were coronary artery disease (14.1%, vs. 5.5% among those without coronary artery disease; odds ratio, 2.81; 95% confidence interval [CI], 1.28 to 6.15), and hypertension (9.5%, vs. 4.9% among those without hypertension; odds ratio, 2.05; 95% CI, 1.10 to 3.82). As of May 11, 2020, 54 (93.1%) re-positive patients turned negative again while two patients remained positive, and two patients was lost to the second follow-up.

Conclusion

Coexisting diseases including coronary artery disease and hypertension were substantial risk factors for re-positive outcomes among patients over 50. And most re-positive patients tended to return negative eventually.

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  1. ScreenIT

    SciScore for 10.1101/2020.06.23.20138149: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: Study oversight: The study was approved by the institutional review board of Wuhan Union Hospital and designed by the authors.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableIndependent-sample T test or T’ test was completed to assess the differences between male and female groups.

    Table 2: Resources

    Antibodies
    SentencesResources
    We obtained clinical information after discharge through follow-up survey, including residual symptoms and laboratory re-examinations results on SARS-COV-2 nucleic acid, chest imaging, and serum antibody.
    SARS-COV-2 nucleic acid, chest imaging,
    suggested: None
    Software and Algorithms
    SentencesResources
    All statistical analyses were performed with SPSS Statistics software, version 26 (IBM).
    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:
    Our study has several limitations. First, the short duration of follow-up makes it hard to determine clinical ends of RP patients. It is uncertain whether they will remain negative or turn positive again. Long-term follow-up are needed to evaluate the possible risk of re-positive patients. Second, some patients had incomplete medical documentation. The anamnesis was considered inexistent if not documented. Third, because Wuhan Union Hospital (West Branch) mainly treats severe and critically ill patients, only 140 mild and moderate patients were included in the follow-up study. It is uncertain whether the conclusions can be generalized to mild and moderate patients. Finally, due to our focus on characteristics of re-positive patients, more attention was paid to harmful factors and some protective factors may be missed. In summary, we demonstrated coronary artery disease and hypertension were associated with an increased risk of re-positive test results for patients over 50. However, re-positive patients tended to turn negative eventually. Our findings also highlight the importance of following up discharged patients because two consecutive negative nucleic acid tests at discharge were not necessarily the endpoints.

    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 10.1101/2020.06.23.20138149v1 on medRxiv