Clinical Characteristics of Recurrent-positive Coronavirus Disease 2019 after Curative Discharge: a retrospective analysis of 15 cases in Wuhan China

  1. Lan Chen
  2. Zhen-Yu Zhang
  3. Xiao-Bin Zhang
  4. Su-Zhen Zhang
  5. Qiu-Ying Han
  6. Zhi-Peng Feng
  7. Jian-Guo Fu
  8. Xiong Xiao
  9. Hui-Min Chen
  10. Li-Long Liu
  11. Xian-Li Chen
  12. Yu-Pei Lan
  13. De-Jin Zhong
  14. Lan Hu
  15. Jun-Hui Wang
  16. Zhen-Yu Yin

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Abstract

In China, the patients with previously negative RT-PCR results again test positive during the post-discharge isolation period. We aimed to determine the clinical characteristics of these “recurrent-positive” patients. We retrospectively reviewed the data of 15 recurrent-positive patients and 107 control patients with non-recurrent, moderate COVID-19 treated in Wuhan, China. Clinical data and laboratory results were comparatively analyzed. We found that recurrent-positive patients had moderate disease. The rate of recurrent-positive disease in our hospital was 1.87%. Recurrent-positive patients were significantly younger (43(35-54) years) than control patients (60(43-69) years) (P=0.011). The early LOS (length of stay in hospital before recurrence) was significantly longer in recurrent-positive patients (36(34-45) days) than in control patients (15(7-30) days) (P =0.001). The time required for the first conversion of RT-PCR results from positive to negative was significantly longer in recurrent-positive patients (14(10-17) days) than in control patients (6(3-9) days) (P =0.011). Serum COVID-19 antibody levels were significantly lower in recurrent-positive patients than in control patients (IgM: 13.69 ± 4.38 vs. 68.10 ± 20.85 AU/mL, P = 0.015; IgG: 78.53 ± 9.30 vs. 147.85 ± 13.33 AU/mL, P < 0.0001). Recurrent-positive patients were younger than control patients. The early LOS (length of stay in hospital before recurrence) was significantly longer in recurrent-positive group than that in control group. COVID-19 IgM/IgG antibody levels were significantly lower in recurrent-positive group than those in control group, which might explain why the virus RNA RT-PCR was positive after the initial “clinical cure”(with three times of virus RNA RT-PCR negative). The virus might not be fully eliminated because of the lower IgG level and their later replicating might result in recurrent-positive virus RNA RT-PCR.

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  1. ScreenIT

    SciScore for 10.1101/2020.07.02.20144873: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethics and consent: The study protocol was approved by the ethics committee of Optics Valley Branch of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, and oral consent was obtained from all enrolled patients.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    All clinical data of the patients were collected, including general data, hospitalization time, time required for the first, second, and third conversions of the RT-PCR results, symptoms, preexisting diseases, and changes in organ function indexes, inflammatory factors, lymphocyte count and ratio, and COVID-19 antibody levels as determined using laboratory examination.
    COVID-19
    suggested: None
    COVID-19 IgM/IgG antibody assays: Serum samples were tested using the COVID-19 IgM and IgG antibody detection kits (chemiluminescence method) were purchased from Shenzhen Yahuilong Biotechnology Co. Ltd. and iflash3000 automatic chemiluminescence immunoassay.
    the COVID-19 IgM
    suggested: None
    IgG antibody detection kits (chemiluminescence method)
    suggested: None
    Software and Algorithms
    SentencesResources
    Negative and positive results were defined as serum IgM and IgG concentrations of <10.0 Au/mL and >10.0 Au/mL, respectively. [10,11] Statistical analysis: SPSS v17.0 software was used for statistical analysis.
    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: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    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 10.1101/2020.07.02.20144873v1 on medRxiv