Recurrence of SARS-CoV-2 PCR positivity in COVID-19 patients: a single center experience and potential implications
Authors: Huang Jia , Zheng Le , Li Zhen , Hao Shiying , Ye Fangfan , Chen Jun , Yao Xiaoming , Liao Jiayu , Wang Song , Zeng Manfei , Qiu Liping , Cen Fanlan , Huang Yajing , Zhu Tengfei , Xu Zehui , Ye Manhua , Yang Yang , Wang Guowei , Li Jinxiu , Wang Lifei , Qu Jiuxin , Yuan Jing , Zheng Wei , Zhang Zheng , Li Chunyang , Whitin John C. , Tian Lu , Chubb Henry , Hwa Kuo-Yuan , Gans Hayley A. , Ceresnak Scott R. , Zhang Wei , Lu Ying , Maldonado Yvonne A. , He Qing , Wang Zhaoqin , Liu Yingxia , McElhinney Doff B. , Sylvester Karl G. , Cohen Harvey J. , Liu Lei , Ling Xuefeng B. 
Published: May 2020

IMPORTANCE

How to appropriately care for patients who become PCR-negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still not known. Patients who have recovered from coronavirus disease 2019 (COVID-19) could profoundly impact the health care system if a subset were to be PCR-positive again with reactivated SARS-CoV-2.

OBJECTIVE

To characterize a single center COVID-19 cohort with and without recurrence of PCR positivity, and develop an algorithm to identify patients at high risk of retest positivity after discharge to inform health care policy and case management decision-making.

DESIGN, SETTING, AND PARTICIPANTS

A cohort of 414 patients with confirmed SARS-CoV-2 infection, at The Second Affiliated Hospital of Southern University of Science and Technology in Shenzhen, China from January 11 to April 23, 2020.

EXPOSURES

Polymerase chain reaction (PCR) and IgM-IgG antibody confirmed SARS-CoV-2 infection.

MAIN OUTCOMES AND MEASURES

Univariable and multivariable statistical analysis of the clinical, laboratory, radiologic image, medical treatment, and clinical course of admission/quarantine/readmission data to develop an algorithm to predict patients at risk of recurrence of PCR positivity.

RESULTS

16.7% (95CI: 13.0%-20.3%) patients retest PCR positive 1 to 3 times after discharge, despite being in strict quarantine. The driving factors in the recurrence prediction model included: age, BMI; lowest levels of the blood laboratory tests during hospitalization for cholinesterase, fibrinogen, albumin, prealbumin, calcium, eGFR, creatinine; highest levels of the blood laboratory tests during hospitalization for total bilirubin, lactate dehydrogenase, alkaline phosphatase; the first test results during hospitalization for partial pressure of oxygen, white blood cell and lymphocyte counts, blood procalcitonin; and the first test episodic Ct value and the lowest Ct value of the nasopharyngeal swab RT PCR results. Area under the ROC curve is 0.786.

CONCLUSIONS AND RELEVANCE

This case series provides clinical characteristics of COVID-19 patients with recurrent PCR positivity, despite strict quarantine, at a 16.7% rate. Use of a recurrence prediction algorithm may identify patients at high risk of PCR retest positivity of SARS-CoV-2 and help modify COVID-19 case management and health policy approaches.

Key Points

Question

What are the characteristics, clinical presentations, and outcomes of COVID-19 patients with PCR retest positivity after resolution of the initial infection and consecutive negative tests? Can we identify recovered patients, prior to discharge, at risk of the recurrence of SARS-CoV-2 PCR positivity?

Findings

In this series of 414 COVID-19 inpatients discharged to a designated quarantine center, 69 retest positive (13 with 2 readmissions, and 3 with 3 readmissions). A multivariable model was developed to predict the risk of the recurrence of SARS-CoV-2 PCR positivity.

Meaning

Rate and timing of the recurrence of PCR positivity following strict quarantine were characterized. Our prediction algorithm may have implications for COVID-19 clinical treatment, patient management, and health policy.