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Diabetes mellitus is a risk factor for prolonged SARS-CoV-2 viral shedding in lower respiratory tract samples of critically ill patients.
Endocrine. 2020 12; 70(3):454-460.E

Abstract

PURPOSE

The length of time a critically ill coronavirus disease 2019 (COVID-19) patient remains infectious and should therefore be isolated remains unknown. This prospective study was undertaken in critically ill patients to evaluate the reliability of single negative real-time polymerase chain reaction (RT-PCR) in lower tracheal aspirates (LTA) in predicting a second negative test and to analyze clinical factors potentially influencing the viral shedding.

METHODS

From April 9, 2020 onwards, intubated COVID-19 patients treated in the intensive care unit were systematically evaluated for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by RT-PCR of nasopharyngeal swabs and LTA. The time to negativity was defined as the time between the onset of symptoms and the viral clearance in LTA. In order to identify risk factors for prolonged viral shedding, we used univariate and multivariate Cox proportional hazards models.

RESULTS

Forty-eight intubated SARS-CoV-2 patients were enrolled. Overall, we observed that the association of the first negative RT-PCR with a second negative result was 96.7%. Median viral shedding was 25 (IQR: 21.5-28) days since symptoms' onset. In the univariate Cox model analysis, type 2 diabetes mellitus was associated with a prolonged viral RNA shedding (hazard ratio [HR]: 0.41, 95% CI: 0.06-3.11, p = 0.04). In the multivariate Cox model analysis, type 2 diabetes was associated with a prolonged viral RNA shedding (HR: 0.31, 95% CI: 0.11-0.89, p = 0.029).

CONCLUSION

Intubated patients with type 2 diabetes mellitus may have prolonged SARS-CoV-2 shedding. In critically ill COVID-19 patients, one negative LTA should be sufficient to assess and exclude infectivity.

Authors+Show Affiliations

Ente Ospedaliero Cantonale, Regional Hospital Locarno, Locarno, Switzerland. University of Paris, INSERM IAME, U1137, Team DeSCID, Paris, France. Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland. pierpaolo.trimboli@eoc.ch. Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland. pierpaolo.trimboli@eoc.ch.Ente Ospedaliero Cantonale, Regional Hospital Locarno, Locarno, Switzerland.Ente Ospedaliero Cantonale, Infection Control Program, Ticino, Switzerland. Ente Ospedaliero Cantonale, Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland.Ente Ospedaliero Cantonale, Infection Control Program, Ticino, Switzerland. Ente Ospedaliero Cantonale, Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland.Institute of Medical Virology, University of Zurich, Zurich, Switzerland.Ente Ospedaliero Cantonale, Regional Hospital Locarno, Locarno, Switzerland.Laboratory of Microbiology EOLAB, Bellinzona, Switzerland.Ente Ospedaliero Cantonale, Regional Hospital Locarno, Locarno, Switzerland. Division Infectious Diseases, Regional Hospital Bellinzona, Bellinzona, Switzerland.Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland. Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland. Department of Clinical Pharmacology and Toxicology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.Ente Ospedaliero Cantonale, Regional Hospital Locarno, Locarno, Switzerland.Ente Ospedaliero Cantonale, Regional Hospital Locarno, Locarno, Switzerland.Ente Ospedaliero Cantonale, Regional Hospital Locarno, Locarno, Switzerland. Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland.Ente Ospedaliero Cantonale, Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland.

Pub Type(s)

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

Language

eng

PubMed ID

32870469

Citation

Buetti, Niccolò, et al. "Diabetes Mellitus Is a Risk Factor for Prolonged SARS-CoV-2 Viral Shedding in Lower Respiratory Tract Samples of Critically Ill Patients." Endocrine, vol. 70, no. 3, 2020, pp. 454-460.
Buetti N, Trimboli P, Mazzuchelli T, et al. Diabetes mellitus is a risk factor for prolonged SARS-CoV-2 viral shedding in lower respiratory tract samples of critically ill patients. Endocrine. 2020;70(3):454-460.
Buetti, N., Trimboli, P., Mazzuchelli, T., Lo Priore, E., Balmelli, C., Trkola, A., Conti, M., Martinetti, G., Elzi, L., Ceschi, A., Consonni, V., Ogna, A., Forni-Ogna, V., & Bernasconi, E. (2020). Diabetes mellitus is a risk factor for prolonged SARS-CoV-2 viral shedding in lower respiratory tract samples of critically ill patients. Endocrine, 70(3), 454-460. https://doi.org/10.1007/s12020-020-02465-4
Buetti N, et al. Diabetes Mellitus Is a Risk Factor for Prolonged SARS-CoV-2 Viral Shedding in Lower Respiratory Tract Samples of Critically Ill Patients. Endocrine. 2020;70(3):454-460. PubMed PMID: 32870469.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diabetes mellitus is a risk factor for prolonged SARS-CoV-2 viral shedding in lower respiratory tract samples of critically ill patients. AU - Buetti,Niccolò, AU - Trimboli,Pierpaolo, AU - Mazzuchelli,Timothy, AU - Lo Priore,Elia, AU - Balmelli,Carlo, AU - Trkola,Alexandra, AU - Conti,Marco, AU - Martinetti,Gladys, AU - Elzi,Luigia, AU - Ceschi,Alessandro, AU - Consonni,Vera, AU - Ogna,Adam, AU - Forni-Ogna,Valentina, AU - Bernasconi,Enos, Y1 - 2020/09/01/ PY - 2020/06/21/received PY - 2020/08/19/accepted PY - 2020/9/2/pubmed PY - 2020/11/26/medline PY - 2020/9/2/entrez KW - COVID-19 KW - Infectivity KW - Intensive care unit KW - SARS-CoV-2 KW - Type 2 diabetes mellitus KW - Viral shedding SP - 454 EP - 460 JF - Endocrine JO - Endocrine VL - 70 IS - 3 N2 - PURPOSE: The length of time a critically ill coronavirus disease 2019 (COVID-19) patient remains infectious and should therefore be isolated remains unknown. This prospective study was undertaken in critically ill patients to evaluate the reliability of single negative real-time polymerase chain reaction (RT-PCR) in lower tracheal aspirates (LTA) in predicting a second negative test and to analyze clinical factors potentially influencing the viral shedding. METHODS: From April 9, 2020 onwards, intubated COVID-19 patients treated in the intensive care unit were systematically evaluated for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by RT-PCR of nasopharyngeal swabs and LTA. The time to negativity was defined as the time between the onset of symptoms and the viral clearance in LTA. In order to identify risk factors for prolonged viral shedding, we used univariate and multivariate Cox proportional hazards models. RESULTS: Forty-eight intubated SARS-CoV-2 patients were enrolled. Overall, we observed that the association of the first negative RT-PCR with a second negative result was 96.7%. Median viral shedding was 25 (IQR: 21.5-28) days since symptoms' onset. In the univariate Cox model analysis, type 2 diabetes mellitus was associated with a prolonged viral RNA shedding (hazard ratio [HR]: 0.41, 95% CI: 0.06-3.11, p = 0.04). In the multivariate Cox model analysis, type 2 diabetes was associated with a prolonged viral RNA shedding (HR: 0.31, 95% CI: 0.11-0.89, p = 0.029). CONCLUSION: Intubated patients with type 2 diabetes mellitus may have prolonged SARS-CoV-2 shedding. In critically ill COVID-19 patients, one negative LTA should be sufficient to assess and exclude infectivity. SN - 1559-0100 UR - https://www.unboundmedicine.com/medline/citation/32870469/Diabetes_mellitus_is_a_risk_factor_for_prolonged_SARS_CoV_2_viral_shedding_in_lower_respiratory_tract_samples_of_critically_ill_patients_ L2 - https://dx.doi.org/10.1007/s12020-020-02465-4 DB - PRIME DP - Unbound Medicine ER -