Association between detectable SARS-COV-2 RNA in anal swabs and disease severity in patients with Coronavirus Disease 2019.

BACKGROUND Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RNA was found in intestines and feces, but its clinical significance is not completely clear. We aim to characterize the longitudinal test results of SARS-CoV-2 RNA in anal swabs, and to explore the association with disease severity. METHODS We included laboratory-confirmed Coronavirus Disease 2019 (COVID-19) patients who hospitalized in Guangzhou Eighth People's Hospital and excluded those who had not received anal swabs for SARS-COV-2 RNA testing. Epidemiological, clinical and laboratory data were obtained. Throat swabs and anal swabs were collected periodically for SARS-COV-2 RNA detection. RESULTS 217 eligible patients (median aged 50 years, 50.2% were females) were analyzed. 21.2% (46/217) of the patients were detectable for SARS-CoV-2 RNA in anal swabs. The duration of viral RNA was longer, but the viral load was lower in anal swabs than throat swabs in the early stage of disease. During a median follow-up of 20 days, 30 (13.8%) patients admitted to intensive care unit (ICU) for high-flow nasal cannula or higher-level oxygen support measures to correct hypoxemia. Detectable viral RNA in anal swabs (adjusted hazard ratio [aHR], 2.50; 95% CI, 1.20-5.24), increased CRP (aHR, 3.14; 95% CI, 1.35-7.32) and lymphocytopenia (aHR, 3.12; 95% CI, 1.46-6.67) were independently associated with ICU admission. The cumulative incidence of ICU admission was higher among patients with detectable viral RNA in anal swabs (26.3% vs. 10.7%, P=0.006). CONCLUSION Detectable SARS-CoV-2 RNA in the digestive tract was a potential warning indicator of severe disease. This article is protected by copyright. All rights reserved.