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Antibody Response to SARS-CoV-2 is Associated with Long-term Clinical Outcome in Patients with COVID-19: a Longitudinal Study, 2021, García-Abellán

Discussion in 'Epidemics (including Covid-19)' started by Andy, Jul 18, 2021 at 11:49 AM.

  1. Andy

    Andy Committee Member (& Outreach when energy allows)

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    Abstract

    Background
    The relationship of host immune response and viral replication with health outcomes in patients with COVID-19 remains to be defined. We aimed to characterize the medium and long-term clinical, virological, and serological outcomes after hospitalization for COVID-19, and to identify predictors of long-COVID.

    Methods
    Prospective, longitudinal study conducted in COVID-19 patients confirmed by RT-PCR. Serial blood and nasopharyngeal samples (NPS) were obtained for measuring SARS-CoV-2 RNA and S-IgG/N-IgG antibodies during hospital stay, and at 1, 2, and 6 months post-discharge. Genome sequencing was performed where appropriate. Patients filled out a COVID-19 symptom questionnaire (CSQ) at 2-month and 6-month visits, and those with highest scores were characterized.

    Results
    Of 146 patients (60% male, median age 64 years) followed-up, 20.6% required hospital readmission and 5.5% died. At 2 months and 6 months, 9.6% and 7.8% patients, respectively, reported moderate/severe persistent symptoms. SARS-CoV-2 RT-PCR was positive in NPS in 11.8% (median Ct = 38) and 3% (median Ct = 36) patients at 2 months and 6 months, respectively, but no reinfections were demonstrated. Antibody titers gradually waned, with seroreversion occurring at 6 months in 27 (27.6%) patients for N-IgG and in 6 (6%) for S-IgG. Adjusted 2-month predictors of the highest CSQ scores (OR [95%CI]) were lower peak S-IgG (0.80 [0.66–0.94]) and higher WHO severity score (2.57 [1.20–5.86]); 6-month predictors were lower peak S-IgG (0.89 [0.79–0.99]) and female sex (2.41 [1.20–4.82]); no association was found with prolonged viral RNA shedding.

    Conclusions
    Long-COVID is associated with weak anti-SARS-CoV-2 antibody response, severity of illness, and female gender. Late clinical events and persistent symptoms in the medium and long term occur in a significant proportion of patients hospitalized for COVID-19.

    Open access, https://link.springer.com/article/10.1007/s10875-021-01083-7
     
  2. strategist

    strategist Senior Member (Voting Rights)

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    I wonder if a weak antibody response is also associated with development of the ME/CFS-like long covid subtype.
     
  3. Snow Leopard

    Snow Leopard Senior Member (Voting Rights)

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    Keeping in mind this patients who happened to attend a specific hospital, it is not an unbiased selection of patients. Only a prospective community-based study would lead to strong conclusions about the relationship between antibody response and Long Covid outcomes. The patients in general may have had higher antibody responses than those who didn't attend hospitals for example.
     
  4. Michiel Tack

    Michiel Tack Senior Member (Voting Rights)

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    The confidence interval suggests that it was just statistically significant, which makes me a bit suspicious.

    Instead of giving a definition of long covid they seem to have used a "score above the third quartile (highest CSQ score) in any of the CSQ items" as the predicted variable. I think it's a bit strange to not use an absolute threshold. If nobody scores high on this questionnaire then the highest scores could still be quite low.
     
    Michelle, Trish, Andy and 1 other person like this.
  5. Michiel Tack

    Michiel Tack Senior Member (Voting Rights)

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    In a sensitivity analysis, the authors also looked at predictors of those who scored equal or above the median CSQ or those with any symptom-CSQ at 6 months follow-up, and in both cases, the results for antibodies were not statistically significant.

    Figure S-5. Sensitivity analyses for predictors, in multivariate regression logistic model, of median-CSQ and any symptom-CSQ at two (panels A and B, respectively) and six (panel C and D, respectively) months of follow-up.

    upload_2021-7-20_9-3-20.png
     
  6. Michiel Tack

    Michiel Tack Senior Member (Voting Rights)

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