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Association between detectable SARS-COV-2 RNA in anal swabs and disease severity in patients with coronavirus disease 2019.
J Med Virol. 2021 02; 93(2):794-802.JM

Abstract

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was found in the intestines and feces, but its clinical significance is not completely clear. We aim to characterize the longitudinal test results of SARS-CoV-2 RNA in anal swabs and to explore the association with disease severity.

METHODS

We included laboratory-confirmed coronavirus disease 2019 (COVID-19) patients, who were hospitalized in Guangzhou Eighth People's Hospital and excluded those who had not received anal swabs for SARS-COV-2 RNA testing. Epidemiological, clinical, and laboratory data were obtained. Throat swabs and anal swabs were collected periodically for SARS-COV-2 RNA detection.

RESULTS

Two hundred and seventeen eligible patients (median aged 50 years, 50.2% were females) were analyzed. 21.2% (46/217) of the patients were detected with SARS-CoV-2 RNA in anal swabs. The duration of viral RNA was longer, but the viral load was lower in anal swabs than throat swabs in the early stage of the disease. During a median follow-up of 20 days, 30 (13.8%) patients were admitted to the intensive care unit (ICU) for high-flow nasal cannula or higher-level oxygen support measures to correct hypoxemia. Detectable viral RNA in anal swabs (adjusted hazard ratio [aHR], 2.50; 95% confidence interval [CI], 1.20-5.24), increased C-reactive protein (aHR, 3.14; 95% CI, 1.35-7.32) and lymphocytopenia (aHR, 3.12; 95% CI, 1.46-6.67) were independently associated with ICU admission. The cumulative incidence of ICU admission was higher among patients with detectable viral RNA in anal swabs (26.3% vs 10.7%, P = .006).

CONCLUSION

Detectable SARS-CoV-2 RNA in the digestive tract was a potential warning indicator of severe disease.

Authors+Show Affiliations

Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.Intensive Care Unit, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.Intensive Care Unit, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.Institute of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.Institute of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.Institute of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.Institute of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32672840

Citation

Lin, Weiyin, et al. "Association Between Detectable SARS-COV-2 RNA in Anal Swabs and Disease Severity in Patients With Coronavirus Disease 2019." Journal of Medical Virology, vol. 93, no. 2, 2021, pp. 794-802.
Lin W, Xie Z, Li Y, et al. Association between detectable SARS-COV-2 RNA in anal swabs and disease severity in patients with coronavirus disease 2019. J Med Virol. 2021;93(2):794-802.
Lin, W., Xie, Z., Li, Y., Li, L., Wen, C., Cao, Y., Chen, X., Ou, X., Hu, F., Li, F., Tang, X., Cai, W., & Li, L. (2021). Association between detectable SARS-COV-2 RNA in anal swabs and disease severity in patients with coronavirus disease 2019. Journal of Medical Virology, 93(2), 794-802. https://doi.org/10.1002/jmv.26307
Lin W, et al. Association Between Detectable SARS-COV-2 RNA in Anal Swabs and Disease Severity in Patients With Coronavirus Disease 2019. J Med Virol. 2021;93(2):794-802. PubMed PMID: 32672840.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between detectable SARS-COV-2 RNA in anal swabs and disease severity in patients with coronavirus disease 2019. AU - Lin,Weiyin, AU - Xie,Zhiwei, AU - Li,Yueping, AU - Li,Liya, AU - Wen,Chunyan, AU - Cao,Yi, AU - Chen,Xiaoting, AU - Ou,Xu, AU - Hu,Fengyu, AU - Li,Feng, AU - Tang,Xiaoping, AU - Cai,Weiping, AU - Li,Linghua, Y1 - 2020/07/27/ PY - 2020/06/23/received PY - 2020/07/07/revised PY - 2020/07/10/accepted PY - 2020/7/17/pubmed PY - 2021/1/15/medline PY - 2020/7/17/entrez KW - COVID-19 KW - SARS-CoV-2 RNA KW - anal swab KW - disease severity SP - 794 EP - 802 JF - Journal of medical virology JO - J Med Virol VL - 93 IS - 2 N2 - BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was found in the intestines and feces, but its clinical significance is not completely clear. We aim to characterize the longitudinal test results of SARS-CoV-2 RNA in anal swabs and to explore the association with disease severity. METHODS: We included laboratory-confirmed coronavirus disease 2019 (COVID-19) patients, who were hospitalized in Guangzhou Eighth People's Hospital and excluded those who had not received anal swabs for SARS-COV-2 RNA testing. Epidemiological, clinical, and laboratory data were obtained. Throat swabs and anal swabs were collected periodically for SARS-COV-2 RNA detection. RESULTS: Two hundred and seventeen eligible patients (median aged 50 years, 50.2% were females) were analyzed. 21.2% (46/217) of the patients were detected with SARS-CoV-2 RNA in anal swabs. The duration of viral RNA was longer, but the viral load was lower in anal swabs than throat swabs in the early stage of the disease. During a median follow-up of 20 days, 30 (13.8%) patients were admitted to the intensive care unit (ICU) for high-flow nasal cannula or higher-level oxygen support measures to correct hypoxemia. Detectable viral RNA in anal swabs (adjusted hazard ratio [aHR], 2.50; 95% confidence interval [CI], 1.20-5.24), increased C-reactive protein (aHR, 3.14; 95% CI, 1.35-7.32) and lymphocytopenia (aHR, 3.12; 95% CI, 1.46-6.67) were independently associated with ICU admission. The cumulative incidence of ICU admission was higher among patients with detectable viral RNA in anal swabs (26.3% vs 10.7%, P = .006). CONCLUSION: Detectable SARS-CoV-2 RNA in the digestive tract was a potential warning indicator of severe disease. SN - 1096-9071 UR - https://www.unboundmedicine.com/medline/citation/32672840/Association_between_detectable_SARS_COV_2_RNA_in_anal_swabs_and_disease_severity_in_patients_with_coronavirus_disease_2019_ DB - PRIME DP - Unbound Medicine ER -