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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  
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Delayed viral clearance 1% Improvement Relative Risk Remdesivir  Arfijanto et al.  LATE TREATMENT Is late treatment with remdesivir beneficial for COVID-19? Retrospective 162 patients in Indonesia (June - December 2021) No significant difference in viral clearance c19early.org Arfijanto et al., Pathophysiology, May 2023 Favorsremdesivir Favorscontrol 0 0.5 1 1.5 2+
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 significantly increased risk of acute kidney injury with remdesivir.
This study is excluded in the after exclusion results of meta analysis: unadjusted results with no group details.
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
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 PaperRemdesivirAll
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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.</jats:p>', 'DOI': '10.3390/pathophysiology30020016', 'type': 'journal-article', 'created': {'date-parts': [[2023, 5, 5]], 'date-time': '2023-05-05T08:55:50Z', 'timestamp': 1683276950000}, 'page': '186-198', 'source': 'Crossref', 'is-referenced-by-count': 0, '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', 'prefix': '10.3390', 'volume': '30', 'author': [ { 'given': 'Muhammad Vitanata', 'family': 'Arfijanto', 'sequence': 'first', 'affiliation': [ { 'name': 'Department of Internal Medicine, Faculty of Medicine, Airlangga ' 'University, Surabaya 60132, Indonesia'}]}, { 'ORCID': 'http://orcid.org/0000-0001-9869-5098', 'authenticated-orcid': False, 'given': 'Tri Pudy', 'family': 'Asmarawati', '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'}]}, { 'given': 'Bramantono', 'family': 'Bramantono', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Faculty of Medicine, Airlangga ' 'University, Surabaya 60132, Indonesia'}]}, { 'ORCID': 'http://orcid.org/0000-0002-4834-2259', 'authenticated-orcid': False, 'given': 'Musofa', 'family': 'Rusli', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Faculty of Medicine, Airlangga ' 'University, Surabaya 60132, Indonesia'}]}, { 'given': 'Brian Eka', 'family': 'Rachman', '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'}]}, { 'ORCID': 'http://orcid.org/0000-0001-6634-6088', 'authenticated-orcid': False, 'given': 'Bagus Aulia', 'family': 'Mahdi', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Faculty of Medicine, Airlangga ' 'University, Surabaya 60132, Indonesia'}]}, { 'given': 'Nasronudin', 'family': 'Nasronudin', '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'}]}, { 'given': 'Usman', 'family': 'Hadi', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Internal Medicine, Faculty of Medicine, Airlangga ' 'University, Surabaya 60132, Indonesia'}]}], 'member': '1968', 'published-online': {'date-parts': [[2023, 5, 4]]}, 'reference': [ { 'key': 'ref_1', 'unstructured': '(2023, March 01). 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Infect.'}], 'container-title': 'Pathophysiology', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://www.mdpi.com/1873-149X/30/2/16/pdf', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2023, 5, 5]], 'date-time': '2023-05-05T09:45:35Z', 'timestamp': 1683279935000}, 'score': 1, 'resource': {'primary': {'URL': 'https://www.mdpi.com/1873-149X/30/2/16'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2023, 5, 4]]}, 'references-count': 36, 'journal-issue': {'issue': '2', 'published-online': {'date-parts': [[2023, 6]]}}, 'alternative-id': ['pathophysiology30020016'], 'URL': 'http://dx.doi.org/10.3390/pathophysiology30020016', 'relation': {}, 'ISSN': ['1873-149X'], 'subject': ['General Medicine'], 'container-title-short': 'Pathophysiology', 'published': {'date-parts': [[2023, 5, 4]]}}
Late treatment
is less effective
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