Excretion of SARS-CoV-2 RNA in feces has no prognostic benefit in the outcome of COVID-19: A clinical and immunological study

Božo Šušak; Monika Dalmatin-Dragišić; Luka Laura; Vinka Mikulić; Katarina Nakić; Ivanka Mikulić; Ilija Brizić; Jurica Arapović; Maja Arapović

doi:10.17305/bb.2024.10176

Authors

Božo Šušak Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina; School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina https://orcid.org/0000-0002-5401-9001
Monika Dalmatin-Dragišić Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina https://orcid.org/0009-0000-4827-4789
Luka Laura Faculty of Pharmacy, University of Mostar, Mostar, Bosnia and Herzegovina https://orcid.org/0009-0001-4905-3299
Vinka Mikulić School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina; Department of Laboratory Diagnostics, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina https://orcid.org/0000-0001-8913-3018
Katarina Nakić School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
Ivanka Mikulić School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina; Department of Laboratory Diagnostics, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
Ilija Brizić Center for Proteomics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia https://orcid.org/0000-0001-8839-7839
Jurica Arapović Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina; School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina https://orcid.org/0000-0002-7674-6795
Maja Arapović School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina https://orcid.org/0000-0001-6043-3666

DOI:

https://doi.org/10.17305/bb.2024.10176

Keywords:

Coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19 testing, immunoglobulin G, vaccination, viral load, feces, signs and symptoms, patient outcome

Abstract

This study explores the correlation between immunological and clinical characteristics in coronavirus disease 2019 (COVID-19) patients with detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in feces, analyzing data from 251 patients admitted to Mostar University Clinical Hospital (UCH) from December 2021 to January 2022. Methods involved reverse transcription quantitative polymerase chain reaction (RT-qPCR) from nasopharyngeal (NP) swabs and feces, alongside serological tests for anti-SARS-CoV-2 spike IgGs. Demographic and clinical data were collected through questionnaires and medical records. The data analyses were performed using SPSS statistical software. Death occurred in 53 patients (21.1%, P < 0.001), mostly in the elderly (47/53, 88.7%, P = 0.001) and immunocompromised (19/53, 35.8%, P = 0.05), particularly those developing acute respiratory insufficiency (ARI) (46/53, 86.8%, P = 0.004), and severe/critical disease (46/53, 86.8%, P = 0.002). Among the patients with positive anti-SARS-CoV-2 IgG antibodies (86/251, 34.3%, P < 0.001), 41 (47.7%) were vaccinated and 45 (52.3%) unvaccinated (P = 0.666), showing no significant differences in clinical outcomes or mortality. Unvaccinated patients with a negative antibody titer had a higher incidence of ARI (96/123, 78%, P = 0.029) and intensive care unit (ICU) admission (22/123, 17.9%, P = 0.026), than those with a positive antibody titer. Forty-seven (62.7%) patients, out of the 75 hospitalized who provided a feces sample, were positive for SARS-CoV-2 RNA (P = 0.028), without statistical differences between fecal SARS-CoV-2 positive and negative groups regarding vaccination status (15/47, 31.9%, P = 0.493), antibody status (18/47, 38.3%, P = 0.628), or death outcome (5/47, 10.6%, P = 0.706). In conclusion, unvaccinated hospitalized patients with a severe COVID-19 presentation and a negative anti-spike SARS-CoV-2 IgG titer had adverse outcomes more frequently. This suggests cautious consideration for the diagnostic use of fecal samples compared to NP swabs.