Duration of SARS-CoV-2 RNA Shedding Is Significantly Influenced by Disease Severity, Bilateral Pulmonary Infiltrates, Antibiotic Treatment, and Diabetic Status: Consideration for Isolation Period

Arfijanto et al., Pathophysiology, doi:10.3390/pathophysiology30020016, May 2023

https://c19early.org/arfijantos.html

Retrospective 162 hospitalized COVID-19 patients in Indonesia, showing no significant difference in delayed viral clearance with remdesivir treatment in unadjusted results.

Gérard, Zhou, Wu, Kamo, Choi, Kim show increased risk of acute kidney injury with remdesivir. Leo, Briciu, Muntean, Petrov show increased risk of liver injury with remdesivir.

This study is excluded in the after exclusion results of meta analysis: unadjusted results with no group details.

Important missing comments or errors? Let us know.

Study covers remdesivir and favipiravir.

delayed viral clearance, 0.9% lower, RR 0.99, p = 1.00, treatment 17 of 44 (38.6%), control 46 of 118 (39.0%), NNT 288.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

1. Gérard et al., Remdesivir and Acute Renal Failure: A Potential Safety Signal From Disproportionality Analysis of the WHO Safety Database, Clinical Pharmacology & Therapeutics, doi:10.1002/cpt.2145.wiley.com, doi.org.

2. Zhou et al., Acute Kidney Injury and Drugs Prescribed for COVID-19 in Diabetes Patients: A Real-World Disproportionality Analysis, Frontiers in Pharmacology, doi:10.3389/fphar.2022.833679.frontiersin.org, doi.org.

3. Wu et al., Acute Kidney Injury Associated With Remdesivir: A Comprehensive Pharmacovigilance Analysis of COVID-19 Reports in FAERS, Frontiers in Pharmacology, doi:10.3389/fphar.2022.692828.frontiersin.org, doi.org.

4. Kamo et al., Association of Antiviral Drugs for the Treatment of COVID-19 With Acute Renal Failure, In Vivo, doi:10.21873/invivo.13637.iiarjournals.org, doi.org.

5. Choi et al., Comparative effectiveness of combination therapy with nirmatrelvir–ritonavir and remdesivir versus monotherapy with remdesivir or nirmatrelvir–ritonavir in patients hospitalised with COVID-19: a target trial emulation study, The Lancet Infectious Diseases, doi:10.1016/S1473-3099(24)00353-0.sciencedirect.com, doi.org.

6. Kim et al., Investigating the Safety Profile of Fast‐Track COVID‐19 Drugs Using the FDA Adverse Event Reporting System Database: A Comparative Observational Study, Pharmacoepidemiology and Drug Safety, doi:10.1002/pds.70043.wiley.com, doi.org.

7. Leo et al., Hepatocellular liver injury in hospitalized patients affected by COVID-19: Presence of different risk factors at different time points, Digestive and Liver Disease, doi:10.1016/j.dld.2021.12.014.sciencedirect.com, doi.org.

8. Briciu et al., Evolving Clinical Manifestations and Outcomes in COVID-19 Patients: A Comparative Analysis of SARS-CoV-2 Variant Waves in a Romanian Hospital Setting, Pathogens, doi:10.3390/pathogens12121453.mdpi.com, doi.org.

9. Muntean et al., Effects of COVID-19 on the Liver and Mortality in Patients with SARS-CoV-2 Pneumonia Caused by Delta and Non-Delta Variants: An Analysis in a Single Centre, Pharmaceuticals, doi:10.3390/ph17010003.mdpi.com, doi.org.

10. Petrov et al., The Effect of Potentially Hepatotoxic Medicinal Products on Alanine Transaminase Levels in COVID-19 Patients: A Case–Control Study, Safety and Risk of Pharmacotherapy, doi:10.30895/2312-7821-2025-458.risksafety.ru, doi.org.

Arfijanto et al., 4 May 2023, retrospective, Indonesia, peer-reviewed, 8 authors, study period June 2021 - December 2021. Contact: tpasmarawati@fk.unair.ac.id (corresponding author).

This Paper Remdesivir All

DOI record: { "DOI": "10.3390/pathophysiology30020016", "ISSN": [ "1873-149X" ], "URL": "http://dx.doi.org/10.3390/pathophysiology30020016", "abstract": "Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) ribonucleic acid (RNA) shedding is an important parameter for determining the optimal length of isolation period required for coronavirus disease 2019 (COVID-19) patients. However, the clinical (i.e., patient and disease) characteristics that could influence this parameter have yet to be determined. In this study, we aim to explore the potential associations between several clinical features and the duration of SARS-CoV-2 RNA shedding in patients hospitalized with COVID-19. A retrospective cohort study involving 162 patients hospitalized for COVID-19 in a tertiary referral teaching hospital in Indonesia was performed from June to December 2021. Patients were grouped based on the mean duration of viral shedding and were compared based on several clinical characteristics (e.g., age, sex, comorbidities, COVID-19 symptoms, severity, and therapies). Subsequently, clinical factors potentially associated with the duration of SARS-CoV-2 RNA shedding were further assessed using multivariate logistic regression analysis. As a result, the mean duration of SARS-CoV-2 RNA shedding was found to be 13 ± 8.44 days. In patients with diabetes mellitus (without chronic complications) or hypertension, the duration of viral shedding was significantly prolonged (≥13 days; p = 0.001 and p = 0.029, respectively). Furthermore, patients with dyspnea displayed viral shedding for longer durations (p = 0.011). The multivariate logistic regression analysis reveals that independent risk factors associated with the duration of SARS-CoV-2 RNA shedding include disease severity (adjusted odds ratio [aOR] = 2.94; 95% CI = 1.36–6.44), bilateral lung infiltrates (aOR = 2.79; 95% CI = 1.14–6.84), diabetes mellitus (aOR = 2.17; 95% CI = 1.02–4.63), and antibiotic treatment (aOR = 3.66; 95% CI = 1.74–7.71). In summary, several clinical factors are linked with the duration of SARS-CoV-2 RNA shedding. Disease severity is positively associated with the duration of viral shedding, while bilateral lung infiltrates, diabetes mellitus, and antibiotic treatment are negatively linked with the duration of viral shedding. Overall, our findings suggest the need to consider different isolation period estimations for specific clinical characteristics of patients with COVID-19 that affect the duration of SARS-CoV-2 RNA shedding.", "alternative-id": [ "pathophysiology30020016" ], "author": [ { "affiliation": [ { "name": "Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya 60132, Indonesia" } ], "family": "Arfijanto", "given": "Muhammad Vitanata", "sequence": "first" }, { "ORCID": "http://orcid.org/0000-0001-9869-5098", "affiliation": [ { "name": "Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya 60132, Indonesia" }, { "name": "Universitas Airlangga Hospital, Airlangga University, Surabaya 60115, Indonesia" } ], "authenticated-orcid": false, "family": "Asmarawati", "given": "Tri Pudy", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya 60132, Indonesia" } ], "family": "Bramantono", "given": "Bramantono", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-4834-2259", "affiliation": [ { "name": "Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya 60132, Indonesia" } ], "authenticated-orcid": false, "family": "Rusli", "given": "Musofa", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya 60132, Indonesia" }, { "name": "Universitas Airlangga Hospital, Airlangga University, Surabaya 60115, Indonesia" } ], "family": "Rachman", "given": "Brian Eka", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0001-6634-6088", "affiliation": [ { "name": "Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya 60132, Indonesia" } ], "authenticated-orcid": false, "family": "Mahdi", "given": "Bagus Aulia", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya 60132, Indonesia" }, { "name": "Universitas Airlangga Hospital, Airlangga University, Surabaya 60115, Indonesia" } ], "family": "Nasronudin", "given": "Nasronudin", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya 60132, Indonesia" } ], "family": "Hadi", "given": "Usman", "sequence": "additional" } ], "container-title": "Pathophysiology", "container-title-short": "Pathophysiology", "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2023, 5, 5 ] ], "date-time": "2023-05-05T08:55:50Z", "timestamp": 1683276950000 }, "deposited": { "date-parts": [ [ 2023, 5, 5 ] ], "date-time": "2023-05-05T09:45:35Z", "timestamp": 1683279935000 }, "indexed": { "date-parts": [ [ 2023, 5, 6 ] ], "date-time": "2023-05-06T04:26:27Z", "timestamp": 1683347187963 }, "is-referenced-by-count": 0, "issue": "2", "issued": { "date-parts": [ [ 2023, 5, 4 ] ] }, "journal-issue": { "issue": "2", "published-online": { "date-parts": [ [ 2023, 6 ] ] } }, "language": "en", "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0/", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2023, 5, 4 ] ], "date-time": "2023-05-04T00:00:00Z", "timestamp": 1683158400000 } } ], "link": [ { "URL": "https://www.mdpi.com/1873-149X/30/2/16/pdf", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "1968", "original-title": [], "page": "186-198", "prefix": "10.3390", "published": { "date-parts": [ [ 2023, 5, 4 ] ] }, "published-online": { "date-parts": [ [ 2023, 5, 4 ] ] }, "publisher": "MDPI AG", "reference": [ { "key": "ref_1", "unstructured": "(2023, March 01). Weekly Epidemiological Update on COVID-19—1 March 2023. Available online: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---1-march-2023." }, { "key": "ref_2", "unstructured": "(2023, March 12). Infeksi Emerging Kementerian Kesehatan RI. Available online: https://infeksiemerging.kemkes.go.id/dashboard/covid-19." }, { "DOI": "10.1002/jmv.26280", "article-title": "Duration of SARS-CoV-2 RNA shedding and factors associated with prolonged viral shedding in patients with COVID-19", "author": "Li", "doi-asserted-by": "crossref", "first-page": "506", "journal-title": "J. Med. Virol.", "key": "ref_3", "volume": "93", "year": "2020" }, { "DOI": "10.1093/cid/ciaa451", "article-title": "Duration of Viral Shedding of Discharged Patients With Severe COVID-19", "author": "Zhou", "doi-asserted-by": "crossref", "first-page": "2240", "journal-title": "Clin. Infect. Dis.", "key": "ref_4", "volume": "71", "year": "2020" }, { "DOI": "10.1172/JCI138759", "article-title": "Kinetics of viral load and antibody response in relation to COVID-19 severity", "author": "Wang", "doi-asserted-by": "crossref", "first-page": "5235", "journal-title": "J. Clin. Investig.", "key": "ref_5", "volume": "130", "year": "2020" }, { "DOI": "10.1183/13993003.01190-2020", "article-title": "Risk factors for viral RNA shedding in COVID-19 patients", "author": "Fu", "doi-asserted-by": "crossref", "first-page": "2001190", "journal-title": "Eur. Respir. J.", "key": "ref_6", "volume": "56", "year": "2020" }, { "DOI": "10.1007/s42399-020-00499-3", "article-title": "A Review of Viral Shedding in Resolved and Convalescent COVID-19 Patients", "author": "Karia", "doi-asserted-by": "crossref", "first-page": "2086", "journal-title": "SN Compr. Clin. Med.", "key": "ref_7", "volume": "2", "year": "2020" }, { "DOI": "10.1016/j.ijid.2021.10.045", "article-title": "COVID-19 in an immunocompromised host: Persistent shedding of viable SARS-CoV-2 and emergence of multiple mutations: A case report", "author": "Leung", "doi-asserted-by": "crossref", "first-page": "178", "journal-title": "Int. J. Infect. Dis.", "key": "ref_8", "volume": "114", "year": "2021" }, { "DOI": "10.1099/acmi.0.000133", "article-title": "Prolonged viral shedding and new mutations of COVID-19 could complicate the control of the pandemic", "author": "Chen", "doi-asserted-by": "crossref", "first-page": "acmi000133", "journal-title": "Access Microbiol.", "key": "ref_9", "volume": "2", "year": "2020" }, { "DOI": "10.1016/j.amsu.2022.103462", "article-title": "National early warning score (NEWS) 2 predicts hospital mortality from COVID-19 patients", "author": "Wibisono", "doi-asserted-by": "crossref", "first-page": "103462", "journal-title": "Ann. Med. Surg.", "key": "ref_10", "volume": "76", "year": "2022" }, { "DOI": "10.12688/f1000research.45046.1", "article-title": "Optimal use of tocilizumab for severe and critical COVID-19: A systematic review and meta-analysis", "author": "Nugroho", "doi-asserted-by": "crossref", "first-page": "73", "journal-title": "F1000Research", "key": "ref_11", "volume": "10", "year": "2021" }, { "DOI": "10.1016/j.vaccine.2022.05.059", "article-title": "Hypertension is asso-ciated with antibody response and breakthrough infection in health care workers following vaccination with inactivated SARS-CoV-2", "author": "Soegiarto", "doi-asserted-by": "crossref", "first-page": "4046", "journal-title": "Vaccine", "key": "ref_12", "volume": "40", "year": "2022" }, { "DOI": "10.5005/jp-journals-10071-24170", "article-title": "Predictive Value of Sequential Organ Failure Assessment, Quick Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation II, and New Early Warning Signs Scores Estimate Mortality of COVID-19 Patients Requiring Intensive Care Unit", "author": "Asmarawati", "doi-asserted-by": "crossref", "first-page": "466", "journal-title": "Indian J. Crit. Care Med.", "key": "ref_13", "volume": "26", "year": "2022" }, { "DOI": "10.12688/f1000research.31645.1", "article-title": "The clinical impact of bacterial co-infection among moderate, severe and critically ill COVID-19 patients in the second referral hospital in Surabaya", "author": "Asmarawati", "doi-asserted-by": "crossref", "first-page": "1", "journal-title": "F1000Research", "key": "ref_14", "volume": "10", "year": "2021" }, { "key": "ref_15", "unstructured": "Burhan, E., Susanto, A.D., Isbaniah, F., Sally, A.N., Eka, G., Ceva, W.P., Susilo, A., Firdaus, I., Santoso, A., and Juzar, D.A. (2020). Pedoman Tatalaksana COVID-19, IDAI. [3rd ed.]." }, { "DOI": "10.1016/j.ijid.2020.05.045", "article-title": "Factors associated with the duration of viral shedding in adults with COVID-19 outside of Wuhan, China: A retrospective cohort study", "author": "Qi", "doi-asserted-by": "crossref", "first-page": "531", "journal-title": "Int. J. Infect. Dis.", "key": "ref_16", "volume": "96", "year": "2020" }, { "DOI": "10.1093/cid/ciaa351", "article-title": "Factors Associated With Prolonged Viral RNA Shedding in Patients with Coronavirus Disease 2019 (COVID-19)", "author": "Xu", "doi-asserted-by": "crossref", "first-page": "799", "journal-title": "Clin. Infect. Dis.", "key": "ref_17", "volume": "71", "year": "2020" }, { "DOI": "10.14336/AD.2020.0630", "article-title": "Clinical Factors Associated with Progression and Prolonged Viral Shedding in COVID-19 Patients: A Multicenter Study", "author": "Feng", "doi-asserted-by": "crossref", "first-page": "1069", "journal-title": "Aging Dis.", "key": "ref_18", "volume": "11", "year": "2020" }, { "DOI": "10.1016/S0140-6736(20)30566-3", "article-title": "Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study", "author": "Zhou", "doi-asserted-by": "crossref", "first-page": "1054", "journal-title": "Lancet", "key": "ref_19", "volume": "395", "year": "2020" }, { "DOI": "10.2147/IDR.S261159", "article-title": "Indicators of Critical Illness and Predictors of Mortality in COVID-19 Patients", "author": "Aly", "doi-asserted-by": "crossref", "first-page": "1995", "journal-title": "Infect. Drug Resist.", "key": "ref_20", "volume": "13", "year": "2020" }, { "DOI": "10.1016/j.jcv.2020.104364", "article-title": "Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan, China", "author": "Zhang", "doi-asserted-by": "crossref", "first-page": "104364", "journal-title": "J. Clin. Virol.", "key": "ref_21", "volume": "127", "year": "2020" }, { "article-title": "Impact of age on duration of viral RNA shedding in patients with COVID-19", "author": "Zhou", "first-page": "22399", "journal-title": "Aging", "key": "ref_22", "volume": "12", "year": "2020" }, { "DOI": "10.1186/s13293-020-00330-7", "article-title": "Sex differences in severity and mortality from COVID-19: Are males more vulnerable?", "author": "Pradhan", "doi-asserted-by": "crossref", "first-page": "53", "journal-title": "Biol. Sex Differ.", "key": "ref_23", "volume": "11", "year": "2020" }, { "DOI": "10.3389/fphys.2021.665064", "article-title": "COVID-19 and Hypertension: The What, the Why, and the How", "author": "Muhamad", "doi-asserted-by": "crossref", "first-page": "665064", "journal-title": "Front. Physiol.", "key": "ref_24", "volume": "12", "year": "2021" }, { "DOI": "10.1007/s12020-020-02465-4", "article-title": "Diabetes mellitus is a risk factor for prolonged SARS-CoV-2 viral shedding in lower respiratory tract samples of critically ill patients", "author": "Buetti", "doi-asserted-by": "crossref", "first-page": "454", "journal-title": "Endocrine", "key": "ref_25", "volume": "70", "year": "2020" }, { "DOI": "10.1016/j.cmet.2020.07.007", "article-title": "Elevated Glucose Levels Favor SARS-CoV-2 Infection and Monocyte Response through a HIF-1α/Glycolysis-Dependent Axis", "author": "Codo", "doi-asserted-by": "crossref", "first-page": "437", "journal-title": "Cell Metab.", "key": "ref_26", "volume": "32", "year": "2020" }, { "DOI": "10.1002/jcla.23923", "article-title": "Risk factors for prolonged virus shedding of respiratory tract and fecal in adults with severe acute respiratory syndrome coronavirus-2 infection", "author": "Zhang", "doi-asserted-by": "crossref", "first-page": "e23923", "journal-title": "J. Clin. Lab. Anal.", "key": "ref_27", "volume": "35", "year": "2021" }, { "DOI": "10.3389/fmed.2021.760170", "article-title": "Atypical Prolonged Viral Shedding With Intra-Host SARS-CoV-2 Evolution in a Mildly Affected Symptomatic Patient", "author": "Cunha", "doi-asserted-by": "crossref", "first-page": "1", "journal-title": "Front. Med.", "key": "ref_28", "volume": "8", "year": "2021" }, { "DOI": "10.1186/s12981-020-00301-3", "article-title": "Case report: One case of coronavirus disease 2019 (COVID-19) in a patient co-infected by HIV with a normal CD4+ T cell count", "author": "Menghua", "doi-asserted-by": "crossref", "first-page": "46", "journal-title": "AIDS Res. Ther.", "key": "ref_29", "volume": "17", "year": "2020" }, { "DOI": "10.1002/ccr3.3786", "article-title": "COVID-19: Prolonged viral shedding in an HIV patient with literature review of risk factors for prolonged viral shedding and its implications for isolation strategies", "author": "Yousaf", "doi-asserted-by": "crossref", "first-page": "1397", "journal-title": "Clin. Case Rep.", "key": "ref_30", "volume": "9", "year": "2021" }, { "DOI": "10.1136/lupus-2020-000396", "article-title": "Thoughts on COVID-19 and autoimmune diseases", "author": "Askanase", "doi-asserted-by": "crossref", "first-page": "e000396", "journal-title": "Lupus Sci. Med.", "key": "ref_31", "volume": "7", "year": "2020" }, { "DOI": "10.1038/s41366-021-00776-8", "article-title": "Obesity in COVID-19 era, implications for mechanisms, comorbidities, and prognosis: A review and meta-analysis", "author": "Aghili", "doi-asserted-by": "crossref", "first-page": "998", "journal-title": "Int. J. Obes.", "key": "ref_32", "volume": "45", "year": "2021" }, { "DOI": "10.1007/s00109-021-02072-4", "article-title": "Obesity and its impact on COVID-19", "author": "Wellen", "doi-asserted-by": "crossref", "first-page": "899", "journal-title": "J. Mol. Med.", "key": "ref_33", "volume": "99", "year": "2021" }, { "DOI": "10.1186/s13613-020-00783-4", "article-title": "Protracted viral shedding and viral load are associated with ICU mortality in Covid-19 patients with acute respiratory failure", "author": "Bitker", "doi-asserted-by": "crossref", "first-page": "167", "journal-title": "Ann. Intensiv. Care", "key": "ref_34", "volume": "10", "year": "2020" }, { "DOI": "10.1111/irv.12065", "article-title": "Factors promoting the prolonged shedding of the pandemic (H1N1) 2009 influenza virus in patients treated with oseltamivir for 5 days", "author": "Ryoo", "doi-asserted-by": "crossref", "first-page": "833", "journal-title": "Influenza Other Respir. Viruses", "key": "ref_35", "volume": "7", "year": "2012" }, { "DOI": "10.1016/j.cmi.2020.07.016", "article-title": "Bacterial co-infection and secondary infection in patients with COVID-19: A living rapid review and meta-analysis", "author": "Langford", "doi-asserted-by": "crossref", "first-page": "1622", "journal-title": "Clin. Microbiol. Infect.", "key": "ref_36", "volume": "26", "year": "2020" } ], "reference-count": 36, "references-count": 36, "relation": {}, "resource": { "primary": { "URL": "https://www.mdpi.com/1873-149X/30/2/16" } }, "score": 1, "short-title": [], "source": "Crossref", "subject": [ "General Medicine" ], "subtitle": [], "title": "Duration of SARS-CoV-2 RNA Shedding Is Significantly Influenced by Disease Severity, Bilateral Pulmonary Infiltrates, Antibiotic Treatment, and Diabetic Status: Consideration for Isolation Period", "type": "journal-article", "volume": "30" }

Late treatment
is less effective

Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. IMA and WCH provide treatment protocols.

Submit

Post

@CovidAnalysis

FAQ

Public domain CC0 1.0