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

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.

Characteristics, risk factors, and outcomes associated with readmission in COVID-19 patients: A systematic review and meta-analysis

“…1 ). Eventually, 36 studies were included in the present systematic review and 28 were incorporated in the meta-analysis [ 7 , 9 , 11 , [13] , [14] , [15] , [16] , 19 , 20 , 23 , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] ]. Overall, 28 articles were included in phase 1 to determine risk factors and outcome of readmitted COVID-19 patients, and 19 articles were included in phase 2 to determine the cause of readmissions.…”

Changes in the trajectory of Long Covid symptoms following COVID-19 vaccination: community-based cohort study

“…However, there was evidence of an increasing trend when the sample was restricted to participants vaccinated during the follow-up period. Relapsing symptoms are common in Long Covid [3][4][5] and persistent symptoms are associated with weak antibody response [28], so it is possible that receiving a first dose alone is insufficient for sustained improvement in some people. With 28,356 adults in our sample, this is the largest study to date internationally on Long Covid and COVID-19 vaccination, and the first to investigate post-vaccine symptom trajectories.…”

“…Relapsing symptoms are common in Long Covid [3][4][5] and persistent symptoms are associated with weak antibody response [28], so it is possible that receiving a first dose alone is insufficient for sustained improvement in some people. With 28,356 adults in our sample, this is the largest study to date internationally on Long Covid and COVID-19 vaccination, and the first to investigate post-vaccine symptom trajectories. The main strength of the study is its use of the CIS, a large survey of approximately half a million people from the community population of the UK with longitudinal follow-up.…”

Back to the Future? Immunoglobulin Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

“…Parallels with ME/CFS in terms of both clinical presentation and biomarkers of immune dysfunction and neuroinflammation are emerging from the study of patients experiencing post-acute sequelae of COVID-19 (PASC) [34,35,[89][90][91][92]. We therefore further conclude that it is plausible that a subgroup of PASC patients may also be helped by IgG.…”

“…Against this background, and with the recent lifting of a longstanding ban on use of UK-sourced blood plasma in the manufacture of immunoglobulins poised to ease global shortages of this product [33] and renewed interest in medium-to long-term immune dysfunctions following viral infection as post-acute sequelae of COVID-19 (PASC) [34,35], a fresh appraisal of this research, supported by published observations from clinical practice, is timely.…”