Clinical scoring system to predict viable viral shedding in patients with COVID-19
- Authors
- Kang, Sung Woon; Park, Heedo; Kim, Ji Yeun; Park, Sunghee; Lim, So Yun; Lee, Sohyun; Bae, Joon-Yong; Kim, Jeonghun; Bae, Seongman; Jung, Jiwon; Kim, Min Jae; Chong, Yong Pil; Lee, Sang-Oh; Choi, Sang-Ho; Kim, Yang Soo; Yun, Sung-Cheol; Park, Man-Seong; Kim, Sung-Han
- Issue Date
- Dec-2022
- Publisher
- Elsevier BV
- Keywords
- COVID-19; Viral shedding; Predictive model; Isolation policy
- Citation
- Journal of Clinical Virology, v.157
- Indexed
- SCIE
SCOPUS
- Journal Title
- Journal of Clinical Virology
- Volume
- 157
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/61806
- DOI
- 10.1016/j.jcv.2022.105319
- ISSN
- 1386-6532
1873-5967
- Abstract
- Background
The Centers for Disease Control and Prevention (CDC) recommends 5–10 days of isolation for patients with COVID-19, depending on symptom duration and severity. However, in clinical practice, an individualized approach is required. We thus developed a clinical scoring system to predict viable viral shedding.
Methods
We prospectively enrolled adult patients with SARS-CoV-2 infection admitted to a hospital or community isolation facility between February 2020 and January 2022. Daily dense respiratory samples were obtained, and genomic RNA viral load assessment and viral culture were performed. Clinical predictors of negative viral culture results were identified using survival analysis and multivariable analysis.
Results
Among 612 samples from 121 patients including 11 immunocompromised patients (5 organ transplant recipients, 5 with hematologic malignancy, and 1 receiving immunosuppressive agents) with varying severity, 154 (25%) revealed positive viral culture results. Multivariable analysis identified symptom onset day, viral copy number, disease severity, organ transplant recipient, and vaccination status as independent predictors of culture-negative rate. We developed a 4-factor predictive model based on viral copy number (-3 to 3 points), disease severity (1 point for moderate to critical disease), organ transplant recipient (2 points), and vaccination status (-2 points for fully vaccinated). Predicted culture-negative rates were calculated through the symptom onset day and the score of the day the sample was collected.
Conclusions
Our clinical scoring system can provide the objective probability of a culture-negative state in a patient with COVID-19 and is potentially useful for implementing personalized de-isolation policies beyond the simple symptom-based isolation strategy.
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- Appears in
Collections - 1. Basic Science > Department of Microbiology > 1. Journal Articles
- 4. Research institute > Institute for Viral Diseases > 1. Journal Articles
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