Analysis on the influencing factors for re-positive nucleic acid test result in discharged COVID-19 patients in Chengdu_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MAO Yi ¹ , TUO Xiaoli ^2,3 , CHEN Hong ⁴ , YANG Ming ⁵ , ZHANG Renqing ¹ ,  JIANG Liangshuang ¹ ,  YUE Yong ^2,3 , PU Ping ¹ , LIU Liangqian ¹ , JIANG Xiaoman ^2,3

1. Emergency Department, Chengdu Public Health Clinical Medical Center, Chengdu, 610061, P. R. China;
2. Chengdu Workstation of Emerging Infectious Diseases, Chinese Academy of Medical Sciences, Chengdu, 610000, P. R. China;
3. Chengdu Center for Disease Control and Prevention, Chengdu, 610000, P. R. China;
4. Department of Critical Care, Chengdu Public Health Clinical Medical Center, Chengdu, 610061, P. R. China;
5. Tuberculosis Department, Chengdu Public Health Clinical Medical Center, Chengdu, 610061, P. R. China;

Corresponding author：

JIANG Liangshuang, Email: 502830704@qq.com; YUE Yong, Email: yueyong@cdcdc.org

Keywords：

Coronavirus disease 2019; nucleic acid test; re-positive; discharged patients; influencing factors

DOI：

10.7507/1007-4848.202106067

Video：

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Objective To analyze the influencing factors for re-positive nucleic acid test in discharged coronavirus disease 2019 (COVID-19) patients in Chengdu, Sichuan Province, and to provide data support for the epidemics prevention and control. Methods The clinical data of 660 discharged COVID-19 patients from January 23, 2020 to February 28, 2021 in our center were retrospectively analyzed. The patients were divided into two groups according to the reexamination of virus nucleic acid, including a negative group [549 patients, including 428 males and 121 females with a median age of 33.0 (28.0, 48.0) years] and a positive group [111 patients, including 76 males and 35 females with a median age of 39.0 (28.0, 51.0) years]. The clinical data of the two groups were compared. Results The re-positive rate of the discharged patients was 16.82%. Univariate analysis showed that the re-positive rate of females was higher than that of males (χ²=4.608, P=0.032). The re-positive rate of confirmed patients was higher than that of asymptomatic infected patients (χ²=8.140, P=0.004). The re-positive rate of domestic patients was higher than that of imported patients (χ²=9.178, P=0.002). The counts of CD3⁺ (P=0.038), CD4⁺ (P=0.048) and CD8⁺ (P=0.040) T lymphocytes in the negative group were higher than those in the positive group. The binary logistic regression analysis showed that the clinical classification and CD8⁺ T lymphocyte count were independent risk factors affecting the recurrence of virility. Conclusion The gender, origin, T lymphocyte subsets count and clinical type are the influencing factors for re-positive result, and clinical type and CD8⁺ T lymphocyte count are the independent influencing factors for re-positive result. Therefore, improving the immunity of infected patients, as well as early detection and timely treatment are effective means to reduce the re-positive occurrence.

Citation： MAO Yi, TUO Xiaoli, CHEN Hong, YANG Ming, ZHANG Renqing, JIANG Liangshuang, YUE Yong, PU Ping, LIU Liangqian, JIANG Xiaoman. Analysis on the influencing factors for re-positive nucleic acid test result in discharged COVID-19 patients in Chengdu. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(2): 173-178. doi: 10.7507/1007-4848.202106067 Copy

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1. 国家卫生健康委. 新型冠状病毒肺炎诊疗方案(试行第八版). [2020-12-18]. URL: http://www.nhc.gov.cn/cms-search/downFiles/a449a3e2e2c94d9a856d5faea2ff0f94.pdf..
2. 中华医学会呼吸病学分会, 中国医师协会呼吸医师分会. 中国成人2019冠状病毒病的诊治与防控指南. 中华医学杂志, 2021, 101(18): 1293-1356.
3. Tao W, Wang X, Zhang G, et al. Re-detectable positive SARS-CoV-2 RNA tests in patients who recovered from COVID-19 with intestinal infection. Protein Cell, 2021, 12(3): 230-235.
4. Gidari A, Nofri M, Saccarelli L, et al. Is recurrence possible in coronavirus disease 2019 (COVID-19)? Case series and systematic review of literature. Eur J Clin Microbiol Infect Dis, 2021, 40(1): 1-12.
5. Lan L, Xu D, Ye G, et al. Positive RT-PCR test results in patients recovered from COVID-19. JAMA, 2020, 323(15): 1502-1503.
6. Dao TL, Hoang VT, Gautret P. Recurrence of SARS-CoV-2 viral RNA in recovered COVID-19 patients: A narrative review. Eur J Clin Microbiol Infect Dis, 2021, 40(1): 13-25.
7. 赵莹, 吴伟慎, 何海艳, 等. 天津市新型冠状病毒肺炎确诊病例治愈出院后核酸阳转情况分析. 第三军医大学学报, 2020, 42(9): 879-882.
8. Yahav D, Yelin D, Eckerle I, et al. Definitions for coronavirus disease 2019 reinfection, relapse and PCR re-positivity. Clin Microbiol Infect, 2021, 27(3): 315-318.
9. 国务院应对新型冠状病毒肺炎疫情联防联控机制综合组. 关于印发新型冠状病毒肺炎防控方案(第七版)的通知. [2020-09-15]. URL: http://www.nhc.gov.cn/jkj/s3577/202009/318683cbfaee4191aee29cd774b19d8d.shtml.
10. 马钰, 马蒙蒙, 罗业飞, 等. 广州市新型冠状病毒肺炎密切接触者感染危险因素分析. 中国公共卫生, 2020, 36(4): 507-511.
11. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020, 395(10223): 497-506.
12. Yao MQ, Zheng QX, Xu J, et al. Factors associated with a SARS-CoV-2 recurrence after hospital discharge among patients with COVID-19: Systematic review and meta-analysis. J Zhejiang Univ Sci B, 2020, 21(12): 940-947.
13. 李浩, 王晓辉, 郑陈丽, 等. 深圳新冠肺炎出院病例核酸复检阳性特征分析. 中国公共卫生, 2020, 36(10): 1393-1395.
14. Ren X, Ren X, Lou J, et al. A systematic review and meta-analysis of discharged COVID-19 patients retesting positive for RT-PCR. EClinicalMedicine, 2021, 34: 100839.
15. Zhuo L, Wei FF, Zhou JQ, et al. Factors influencing the outcome of 34 patients with COVID-19. J Pract Med, 2020, 36(14): 1861-1865.
16. Ye H, Zhao C, Yang L, et al. Twelve out of 117 recovered COVID-19 patients retest positive in a single-center study of China. EClinicalMedicine, 2020, 26: 100492.
17. Zhou J, Zhang J, Zhou J, et al. Clinical characteristics of re-positive COVID-19 patients in Huangshi, China: A retrospective cohort study. PLoS One, 2020, 15(11): e0241896.
18. Altmann DM, Boyton RJ. SARS-CoV-2 T cell immunity: Specificity, function, durability, and role in protection. Sci Immunol, 2020, 5(49): eabd6160.
19. Bellesi S, Metafuni E, Hohaus S, et al. Increased CD95 (Fas) and PD-1 expression in peripheral blood T lymphocytes in COVID-19 patients. Br J Haematol, 2020, 191(2): 207-211.
20. Remy KE, Mazer M, Striker DA, et al. Severe immunosuppression and not a cytokine storm haracterizes COVID-19 infections. JCI Insight, 2020, 5(17): e140329.
21. Elsayed SM, Reddy MK, Murthy PM, et al. The possibility and cause of relapse after previously recovering from COVID-19: A systematic review. Cureus, 2020, 12(9): e10264.
22. To KK, Tsang OT, Leung WS, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: An observational cohort study. Lancet Infect Dis, 2020, 20(5): 565-574.
23. Chen J, Xu X, Hu J, et al. Clinical course and risk factors for recurrence of positive SARS-CoV-2 RNA: A retrospective cohort study from Wuhan, China. Aging (Albany NY), 2020, 12(17): 16675-16689.
24. Chen SL, Xu H, Feng HY, et al. Epidemiological and clinical findings of short-term recurrence of severe acute respiratory syndrome coronavirus 2 ribonucleic acid polymerase chain reaction positivity in 1282 discharged coronavirus disease 2019 cases: A multicenter, retrospective, observational study. Open Forum Infect Dis, 2020, 7(10): ofaa432.
25. Hu W, Wang M, chang C, et al. Characteristics and risk factors analysis for "RNA re-tested positive" in patients recovering from COVID-19. Life Sci Res, 2020: 1-16.
26. Xiao AT, Tong YX, Zhang S. False negative of RT-PCR and prolonged nucleic acid conversion in COVID-19: Rather than recurrence. J Med Virol, 2020, 92(10): 1755-1756.
27. Huang J, Zheng L, Li Z, et al. Recurrence of SARS CoV-2 PCR positivity in COVID-19 patients: A single center experience and potential implications. MedRxiv, 2020. [Epub ahead of print].
28. 邹莉萍, 毛毅, 罗海霞, 等. 成都市新型冠状病毒感染境外输入患者与相关本土患者的临床分析. 中国胸心血管外科临床杂志, 2021, 28(9): 1021-1028.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis on the influencing factors for re-positive nucleic acid test result in discharged COVID-19 patients in Chengdu

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