Proinflammatory cytokines are associated with prolonged viral RNA shedding in COVID-19 patients

Clin Immunol. 2020 Dec:221:108611. doi: 10.1016/j.clim.2020.108611. Epub 2020 Oct 14.

Abstract

Since December 2019, Coronavirus Disease 2019 (COVID-19) has emerged as a global pandemic. We aimed to investigate the clinical characteristics and analyzed the risk factors for prolonged viral RNA shedding. We retrospectively collected data from 112 hospitalized COVID-19 patients in a single center in Wuhan, China. Factors associated with prolonged viral RNA shedding (≥28 days) were investigated. Forty-nine (43.8%) patients had prolonged viral RNA shedding. Patients with prolonged viral shedding were older and had a higher rate of hypertension. Proinflammatory cytokines, including interleukin-2R (IL-2R) and tumor necrosis factor-α (TNF-α), were significantly elevated in patients with prolonged viral shedding. Multivariate analysis revealed that hypertension, older age, lymphopenia and elevated serum IL-2R were independent risk factors for prolonged viral shedding. This comprehensive investigation revealed the distinct characteristics between patients with or without prolonged viral RNA shedding. Hypertension, older age, lymphopenia and high levels of proinflammatory cytokines may be correlated with prolonged viral shedding.

Keywords: Coronavirus disease 2019; Lymphopenia; Proinflammatory cytokines; Prolonged viral RNA shedding; SARS-CoV-2.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19 / diagnosis
  • COVID-19 / immunology
  • COVID-19 / virology*
  • COVID-19 Drug Treatment
  • China
  • Comorbidity
  • Cytokine Release Syndrome / diagnosis
  • Cytokine Release Syndrome / drug therapy
  • Cytokine Release Syndrome / immunology
  • Cytokine Release Syndrome / virology*
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / drug therapy
  • Diabetes Mellitus / immunology
  • Diabetes Mellitus / virology*
  • Drug Combinations
  • Female
  • Hospitalization
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Hypertension / diagnosis
  • Hypertension / drug therapy
  • Hypertension / immunology
  • Hypertension / virology*
  • Interferons / therapeutic use
  • Lopinavir / therapeutic use
  • Lymphopenia / diagnosis
  • Lymphopenia / drug therapy
  • Lymphopenia / immunology
  • Lymphopenia / virology*
  • Male
  • Middle Aged
  • RNA, Viral / blood*
  • Receptors, Interleukin-2 / biosynthesis
  • Retrospective Studies
  • Risk Factors
  • Ritonavir / therapeutic use
  • SARS-CoV-2 / pathogenicity*
  • Severity of Illness Index
  • Tumor Necrosis Factor-alpha / biosynthesis
  • Virus Shedding

Substances

  • Adrenal Cortex Hormones
  • Drug Combinations
  • RNA, Viral
  • Receptors, Interleukin-2
  • Tumor Necrosis Factor-alpha
  • lopinavir-ritonavir drug combination
  • Lopinavir
  • Hydroxychloroquine
  • Interferons
  • Ritonavir