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Journal of Zhejiang University SCIENCE B 1998 Vol.-1 No.-1 P.

http://doi.org/10.1631/jzus.B2000608


Development and Validation of An Individualized Nomogram for Early Prediction of the Duration of SARS-CoV-2 Shedding in COVID-19 Patients with Non-severe Disease


Author(s):  Shijin YUAN, Yong PAN, Yan XIA, Yan ZHANG, Jiangnan CHEN, Wei ZHENG, Xiaoping XU, Xinyou XIE, Jun ZHANG

Affiliation(s):  Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China; more

Corresponding email(s):   jameszhang2000@zju.edu.cn, scottxie@zju.edu.cn

Key Words:  COVID-19, SARS-CoV-2, Duration of viral shedding, Nomogram


Shijin YUAN, Yong PAN, Yan XIA, Yan ZHANG, Jiangnan CHEN, Wei ZHENG, Xiaoping XU, Xinyou XIE, Jun ZHANG. Development and Validation of An Individualized Nomogram for Early Prediction of the Duration of SARS-CoV-2 Shedding in COVID-19 Patients with Non-severe Disease[J]. Journal of Zhejiang University Science B, 1998, -1(-1): .

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A1 - Yan ZHANG
A1 - Jiangnan CHEN
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A1 - Xinyou XIE
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Abstract: 
With the number of cases of coronavirus disease-2019 (COVID-19) increasing rapidly, the World Health Organization has recommended that patients with mild or moderate symptoms could be released from quarantine without nucleic acid retesting, and self-isolate in the community. This may pose a potential virus transmission risk. We aimed to develop a nomogram to predict the duration of viral shedding for individual COVID-19 patients. This retrospective multicentric study enrolled 135 patients as a training cohort and 102 patients as a validation cohort. Significant factors associated with the duration of viral shedding were identified by multivariate Cox modeling in the training cohort and combined to develop a nomogram to predict the probability of viral shedding at 9, 13, 17 and 21 days after admission. The nomogram was validated in the validation cohort and evaluated by a concordance index (C-index), area under the curve (AUC), and calibration curves. A higher absolute lymphocyte count (P=0.001) and lymphocyte-to-monocyte ratio (P=0.013) were correlated with a shorter duration of viral shedding, while a longer activated partial thromboplastin time (P=0.007) prolonged the viral shedding duration. The C-indices of the nomogram were 0.732 (95% CI: 0.685-0.777) in the training cohort and 0.703 (95% CI: 0.642-0.764) in the validation cohort. The AUC showed a good discriminative ability (training cohort: 9 days: 0.879; 13 days: 0.762; 17 days: 0.738; 21 days: 0.715; validation cohort: 9 days: 0.855; 13 days: 0.758; 17 days: 0.728; 21 days: 0.706), and calibration curves were consistent between outcomes and predictions in both cohorts. A predictive nomogram for viral shedding duration based on three easily accessible factors was developed to help estimate appropriate self-isolation times for patients with mild or moderate symptoms, and to control virus transmission.

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