Diabetes mellitus is a risk factor for prolonged SARS-CoV-2 viral shedding in lower respiratory tract samples of critically ill patients

Buetti, Niccolò; Trimboli, Pierpaolo; Mazzuchelli, Timothy; Lo Priore, Elia; Balmelli, Carlo; Trkola, Alexandra; Conti, Marco; Martinetti, Gladys; Elzi, Luigia; Ceschi, Alessandro; Consonni, Vera; Ogna, Adam; Forni-Ogna, Valentina; Bernasconi, Enos

doi:10.1007/s12020-020-02465-4

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Journal article

Diabetes mellitus is a risk factor for prolonged SARS-CoV-2 viral shedding in lower respiratory tract samples of critically ill patients

Buetti, Niccolò Ente Ospedaliero Cantonale, Regional Hospital 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, Switzerland
Trimboli, Pierpaolo Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland - Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
Mazzuchelli, Timothy Ente Ospedaliero Cantonale, Regional Hospital Locarno, Switzerland
Lo Priore, Elia Ente Ospedaliero Cantonale, Infection Control Program, Ticino, Switzerland - Ente Ospedaliero Cantonale, Division of Infectious Diseases, Regional Hospital Lugano, Switzerland
Balmelli, Carlo Ente Ospedaliero Cantonale, Infection Control Program, Ticino, Switzerland - Ente Ospedaliero Cantonale, Division of Infectious Diseases, Regional Hospital Lugano, Switzerland
Trkola, Alexandra Institute of Medical Virology, University of Zurich, Switzerland
Conti, Marco Ente Ospedaliero Cantonale, Regional Hospital Locarno, Switzerland
Martinetti, Gladys Laboratory of Microbiology EOLAB, Bellinzona, Switzerland
Elzi, Luigia Ente Ospedaliero Cantonale, Regional Hospital Locarno, Switzerland - Division Infectious Diseases, Regional Hospital Bellinzona, Switzerland
Ceschi, Alessandro Faculty of Biomedical Sciences, Università della Svizzera italiana, 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, Switzerland
Consonni, Vera Ente Ospedaliero Cantonale, Regional Hospital Locarno, Switzerland
Ogna, Adam Ente Ospedaliero Cantonale, Regional Hospital Locarno, Switzerland
Forni-Ogna, Valentina Ente Ospedaliero Cantonale, Regional Hospital Locarno, Switzerland - Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
Bernasconi, Enos Ente Ospedaliero Cantonale, Division of Infectious Diseases, Regional Hospital Lugano, Switzerland

01.09.2020

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Endocrine. - 2020, vol. 70, p. 454–460

English 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. 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. 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). 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.

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