Dynamics and Correlation Among Viral Positivity, Seroconversion, and Disease Severity in COVID-19 : A Retrospective Study
BACKGROUND: The understanding of viral positivity and seroconversion during the course of coronavirus disease 2019 (COVID-19) is limited.
OBJECTIVE: To describe patterns of viral polymerase chain reaction (PCR) positivity and evaluate their correlations with seroconversion and disease severity.
DESIGN: Retrospective cohort study.
SETTING: 3 designated specialty care centers for COVID-19 in Wuhan, China.
PARTICIPANTS: 3192 adult patients with COVID-19.
MEASUREMENTS: Demographic, clinical, and laboratory data.
RESULTS: Among 12 780 reverse transcriptase PCR tests for severe acute respiratory syndrome coronavirus 2 that were done, 24.0% had positive results. In 2142 patients with laboratory-confirmed COVID-19, the viral positivity rate peaked within the first 3 days. The median duration of viral positivity was 24.0 days (95% CI, 18.9 to 29.1 days) in critically ill patients and 18.0 days (CI, 16.8 to 19.1 days) in noncritically ill patients. Being critically ill was an independent risk factor for longer viral positivity (hazard ratio, 0.700 [CI, 0.595 to 0.824]; P < 0.001). In patients with laboratory-confirmed COVID-19, the IgM-positive rate was 19.3% in the first week, peaked in the fifth week (81.5%), and then decreased steadily to around 55% within 9 to 10 weeks. The IgG-positive rate was 44.6% in the first week, reached 93.3% in the fourth week, and then remained high. Similar antibody responses were seen in clinically diagnosed cases. Serum inflammatory markers remained higher in critically ill patients. Among noncritically ill patients, a higher proportion of those with persistent viral positivity had low IgM titers (<100 AU/mL) during the entire course compared with those with short viral positivity.
LIMITATION: Retrospective study and irregular viral and serology testing.
CONCLUSION: The rate of viral PCR positivity peaked within the initial few days. Seroconversion rates peaked within 4 to 5 weeks. Dynamic laboratory index changes corresponded well to clinical signs, the recovery process, and disease severity. Low IgM titers (<100 AU/mL) are an independent risk factor for persistent viral positivity.
PRIMARY FUNDING SOURCE: None.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:174 |
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| Enthalten in: |
Annals of internal medicine - 174(2021), 4 vom: 02. Apr., Seite 453-461 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Fu, Yu [VerfasserIn] |
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| Links: |
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| Themen: |
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| Anmerkungen: |
Date Completed 30.04.2021 Date Revised 30.04.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.7326/M20-3337 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM318505169 |
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| 100 | 1 | |a Fu, Yu |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Dynamics and Correlation Among Viral Positivity, Seroconversion, and Disease Severity in COVID-19 |b A Retrospective Study |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 30.04.2021 | ||
| 500 | |a Date Revised 30.04.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: The understanding of viral positivity and seroconversion during the course of coronavirus disease 2019 (COVID-19) is limited | ||
| 520 | |a OBJECTIVE: To describe patterns of viral polymerase chain reaction (PCR) positivity and evaluate their correlations with seroconversion and disease severity | ||
| 520 | |a DESIGN: Retrospective cohort study | ||
| 520 | |a SETTING: 3 designated specialty care centers for COVID-19 in Wuhan, China | ||
| 520 | |a PARTICIPANTS: 3192 adult patients with COVID-19 | ||
| 520 | |a MEASUREMENTS: Demographic, clinical, and laboratory data | ||
| 520 | |a RESULTS: Among 12 780 reverse transcriptase PCR tests for severe acute respiratory syndrome coronavirus 2 that were done, 24.0% had positive results. In 2142 patients with laboratory-confirmed COVID-19, the viral positivity rate peaked within the first 3 days. The median duration of viral positivity was 24.0 days (95% CI, 18.9 to 29.1 days) in critically ill patients and 18.0 days (CI, 16.8 to 19.1 days) in noncritically ill patients. Being critically ill was an independent risk factor for longer viral positivity (hazard ratio, 0.700 [CI, 0.595 to 0.824]; P < 0.001). In patients with laboratory-confirmed COVID-19, the IgM-positive rate was 19.3% in the first week, peaked in the fifth week (81.5%), and then decreased steadily to around 55% within 9 to 10 weeks. The IgG-positive rate was 44.6% in the first week, reached 93.3% in the fourth week, and then remained high. Similar antibody responses were seen in clinically diagnosed cases. Serum inflammatory markers remained higher in critically ill patients. Among noncritically ill patients, a higher proportion of those with persistent viral positivity had low IgM titers (<100 AU/mL) during the entire course compared with those with short viral positivity | ||
| 520 | |a LIMITATION: Retrospective study and irregular viral and serology testing | ||
| 520 | |a CONCLUSION: The rate of viral PCR positivity peaked within the initial few days. Seroconversion rates peaked within 4 to 5 weeks. Dynamic laboratory index changes corresponded well to clinical signs, the recovery process, and disease severity. Low IgM titers (<100 AU/mL) are an independent risk factor for persistent viral positivity | ||
| 520 | |a PRIMARY FUNDING SOURCE: None | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 7 | |a Antibodies, Viral |2 NLM | |
| 700 | 1 | |a Li, Yongsheng |e verfasserin |4 aut | |
| 700 | 1 | |a Guo, Ensong |e verfasserin |4 aut | |
| 700 | 1 | |a He, Liang |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, Jia |e verfasserin |4 aut | |
| 700 | 1 | |a Yang, Bin |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Fuxia |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Zizhuo |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Yuan |e verfasserin |4 aut | |
| 700 | 1 | |a Xiao, Rourou |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, Chen |e verfasserin |4 aut | |
| 700 | 1 | |a Huang, Yuhan |e verfasserin |4 aut | |
| 700 | 1 | |a Wu, Xue |e verfasserin |4 aut | |
| 700 | 1 | |a Lu, Funian |e verfasserin |4 aut | |
| 700 | 1 | |a You, Lixin |e verfasserin |4 aut | |
| 700 | 1 | |a Qin, Tianyu |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Chaolong |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Kezhen |e verfasserin |4 aut | |
| 700 | 1 | |a Wu, Peng |e verfasserin |4 aut | |
| 700 | 1 | |a Ma, Ding |e verfasserin |4 aut | |
| 700 | 1 | |a Sun, Chaoyang |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Gang |e verfasserin |4 aut | |
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