Persistent viral RNA shedding of SARS-CoV-2 is associated with delirium incidence and six-month mortality in hospitalized COVID-19 patients

Ayush Batra, Jeffrey R. Clark, Anthony K. Kang, Sareen Ali, Tulsi R. Patel, Nathan A. Shlobin, Steven C. Hoffman, Patrick H. Lim, Zachary S. Orban, Lavanya Visvabharathy, Edith L. Graham, David P. Sullivan, William A. Muller, Sherry H.Y. Chou, Zoltán Ungvári, Igor J. Koralnik, Eric M. Liotta*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background: Persistent viral RNA shedding of SARS-CoV-2 following COVID-19 has increasingly been recognized, with limited understanding of its implications on outcomes in hospitalized COVID-19 patients. Methods: We retrospectively assessed for persistent viral shedding across Northwestern Medicine Healthcare (NMHC) patients between March and August 2020. We assessed for predictors of persistent viral shedding, in-hospital delirium, and six-month mortality using binary logistic regression. Results: Of the 2,518 hospitalized patients with an RT-PCR-confirmed diagnosis of COVID-19, 959 underwent repeat SARS-CoV-2 RT-PCR at least fourteen days from initial positive testing. Of those, 405 (42.2%) patients were found to have persistent viral shedding. Persistent viral shedding was associated with male sex, increased BMI, diabetes mellitus, chronic kidney disease, and exposure to corticosteroids during initial COVID-19 hospitalization. Persistent viral shedding was independently associated with incidence of in-hospital delirium after adjusting for factors including severity of respiratory dysfunction (OR 2.45; 95% CI 1.75, 3.45). Even after adjusting for age, severity of respiratory dysfunction, and occurrence of in-hospital delirium, persistent viral shedding remained significantly associated with increased six-month mortality (OR 2.43; 95% CI 1.42, 4.29). Conclusions: Persistent viral shedding occurs frequently in hospitalized COVID-19 patients and is associated with in-hospital delirium and increased six-month mortality.

Original languageEnglish (US)
Pages (from-to)1241-1254
Number of pages14
Issue number3
StatePublished - Jun 2022


  • COVID-19
  • Delirium
  • SARS-CoV-2
  • Viral Shedding

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Cardiology and Cardiovascular Medicine
  • Aging
  • Complementary and alternative medicine
  • veterinary (miscalleneous)


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