Abstract
Severe/critical patients with coronavirus disease 2019 (COVID-19) have become the central issue in the current global pandemic due to their high mortality rate. However, the relationship between antibody response and clinical outcomes has not been well described in this group. We conducted a single-center, retrospective, cohort study to investigate the relationship between serum immunoglobulin G (IgG) and IgM and clinical outcomes in severe/critical patients with COVID-19. Seventy-nine severe/critical patients with COVID-19 admitted in Wuhan Asia General Hospital in Wuhan, China during January 22, 2020 to March 6, 2020 were included. Serum antibodies were measured at day 25 (SD, 7) post illness onset. The median IgG titer was 113 (IQR 81-167) AU/ml, and IgM titer was 50 (IQR, 23-105) AU/ml. Patients whose IgM titer ≥ 50 AU/ml had higher in-hospital mortality (p=0.026). IgM titer ≥ 50 AU/ml was also correlated with higher incidences of Acute Respiratory Distress Syndrome (ARDS) and sepsis shock. Antibody remeasurements were performed in 42 patients, where IgM titer declined significantly in survivors (p=0.031). Serum IgM titer changes according to the COVID-19 progression. The severe/critical patients with COVID-19 have a higher risk of clinical adverse events when IgM titer ≥ 50 AU/ml. Further decreasing of IgM could imply a better outcome in severe/critical cases.
Highlights
Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China in December 2019
The titers of IgM and immunoglobulin G (IgG) were significantly correlated with viral load in patients infected by SARS-CoV-2 in a recent finding [14], which promoted the hypothesis that specific antibody against virus might be associated with disease progression in COVID-19
We investigated the serum titers of specific antibodies, IgG and IgM, in severe/critical patients with COVID-19 to explore the association between serum antibody titers and the clinical adverse events in those patients
Summary
Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China in December 2019. Severe/critical patients with COVID-19 contributed only 4~15% to overall infected population in different countries [7, 8], attentions have been paid to them because of their rapid progression in disease, and due to the greater difficulties in treatment and higher mortality rate [7, 9, 10]. Specific serum immunoglobulin G (IgG) and IgM against SARS-CoV or Middle East Respiratory Syndrome-coronavirus (MERS-CoV) became detectable in patients as early as 11-15 days post illness onset [11, 12]. The titers of IgM and IgG were significantly correlated with viral load in patients infected by SARS-CoV-2 in a recent finding [14], which promoted the hypothesis that specific antibody against virus might be associated with disease progression in COVID-19. Reports on clinical profiles of antibody response in severe/critical patients with COVID-19 are scarce. We investigated the serum titers of specific antibodies, IgG and IgM, in severe/critical patients with COVID-19 to explore the association between serum antibody titers and the clinical adverse events in those patients
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