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Research Article | Open Access

Associations of clinical features and dynamic immune response with the duration of viral RNA shedding in patients with COVID-19

Xiaohua Chen2,§, Yao Deng3,§, Qian Shen1,§, Rong Zhang4,5, Yong Qi6, Jingjing Chen7, Zequn Lu1, Lin Miao2, Jinya Ding2( ), Rong Zhong1( )
Department of Epidemiology and Biostatistics and Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Department of Laboratory Medicine, General Hospital of Central Theatre Command, Wuhan 430070, China
Zhuhai Precision Medical Center, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai 519000, China
Department of Laboratory Medicine, General Hospital of Southern Theatre Command, Guangzhou 510010, China
Joint Expert Group for COVID-19, Wuhan Huoshenshan Hospital, Wuhan 430100, China
Medical Department General Hospital of Central Theatre Command, Wuhan 430070, China
Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China

§ Xiaohua Chen, Yao Deng, and Qian Shen contributed equally to this work.

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Graphical Abstract

Abstract

Background

Clinical features and the dynamic changes of the immune response in coronavirus disease-2019 (COVID-19) patients play essential roles in the disease courses. We hypothesized that clinical features and longitudinal dynamic immune response of COVID-19 patients might be associated with viral shedding duration.

Methods

In this retrospective study, we documented 413 adult patients with laboratory-confirmed COVID-19 from Wuhan Huoshenshan Hospital. Demographic, clinical, and laboratory data were extracted from electronic medical records. Risk factors associated with viral shedding duration were examined using odds ratios (ORs) and 95% confidence intervals (CIs) in the multivariable logistic regression models.

Results

The median duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral shedding was 48 days (interquartile range, 40–58 days) among all patients. Fever symptom (OR, 2.23; 95% CI, 1.46–3.44), delayed admission after symptom onset (OR, 15.33; 95% CI, 9.14–26.65), CD8+ T cells (OR, 1.93; 95% CI, 1.10–3.44) were associated with prolonged viral shedding. In contrast, shorter viral shedding was associated with CD4+ T cells (OR, 0.38; 95% CI, 0.16–0.88), the ratios of CD4+ T cells to CD8+ T cells (OR, 0.79; 95% CI, 0.63–0.98). Longitudinal dynamic analyses demonstrate that sustained monocyte level was associated with shorter viral shedding (OR, 0.41; 95% CI, 0.22–0.76). More importantly, the associations of CD4+ T cells, CD8+ T cells, the ratio of CD4+ T cells to CD8+ T cells, and sustained monocyte level were confined to male patients.

Conclusions

Higher CD4+ T cells, sustained monocyte level, and lower CD8+ T cells might shorten the disease course. The male-specific associations supported the contribution of sex-dependent immune responses to the disease courses.

Keywords

risk factorsimmunitysevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2)dynamic changesdisease course

Electronic Supplementary Material

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Nano TransMed
Volume 2 Issue 1,
March 2023
Article number: e9130015
DOI: 10.26599/NTM.2023.9130015
Cite this article:
Chen X, Deng Y, Shen Q, et al. Associations of clinical features and dynamic immune response with the duration of viral RNA shedding in patients with COVID-19. Nano TransMed, 2023, 2(1): e9130015. https://doi.org/10.26599/NTM.2023.9130015

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Received: 27 February 2023
Accepted: 26 March 2023
Published: 30 March 2023
© The Author(s) 2023. Nano TransMed published by Tsinghua University Press.

The articles published in this open access journal are distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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