Autoimmune and immunoserological markers of COVID-19 pneumonia: Can they help in the assessment of disease severity

Abstract

BackgroundImmune dysregulation and associated inefficient anti-viral immunity during Coronavirus Disease 2019 (COVID-19) can cause tissue and organ damage which shares many similarities with pathogenetic processes in systemic autoimmune diseases. In this study, we investigate wide range autoimmune and immunoserological markers in hospitalized patients with COVID-19.MethodsStudy included 51 patients with confirmed Severe Acute Respiratory Syndrome Coronavirus 2 infection and hospitalized due to COVID-19 pneumonia. Wide spectrum autoantibodies associated with different autoimmune inflammatory rheumatic diseases were analyzed and correlated with clinical and laboratory features and pneumonia severity.ResultsAntinuclear antibodies (ANA) positivity was found in 19.6%, anti-cardiolipin IgG antibodies (aCL IgG) in 15.7%, and anti-cardiolipin IgM antibodies (aCL IgM) in 7.8% of patients. Positive atypical x anti-neutrophil cytoplasmic antibodies (xANCA) were detected in 10.0% (all negative for Proteinase 3 and Myeloperoxidase) and rheumatoid factor was found in 8.2% of patients. None of tested autoantibodies were associated with disease or pneumonia severity, except for aCL IgG being significantly associated with higher pneumonia severity index (p = 0.036). Patients with reduced total serum IgG were more likely to require non-invasive mechanical ventilation (NIMV) (p < 0.0001). Serum concentrations of IgG (p = 0.003) and IgA (p = 0.032) were significantly lower in this group of patients. Higher total serum IgA (p = 0.009) was associated with mortality, with no difference in serum IgG (p = 0.115) or IgM (p = 0.175). Lethal outcome was associated with lower complement C4 (p = 0.013), while there was no difference in complement C3 concentration (p = 0.135).ConclusionIncreased autoimmune responses are present in moderate and severe COVID-19. Severe pneumonia is associated with the presence of aCL IgG, suggesting their role in disease pathogenesis. Evaluation of serum immunoglobulins and complement concentration could help assess the risk of non-invasive mechanical ventilation NIMV and poor outcome.

Importancia clínica de los anticuerpos antinucleares en la COVID-19: una revisión sistemática con síntesis narrativa

“…Anticuerpos antinucleares en COVID-19 parte, los desenlaces informados asociados con la positividad de ANA también mostraron heterogeneidad. Mientras que algunos estudios establecieron una relación entre la positividad de ANA y los desenlaces adversos, como mortalidad, ingreso en la unidad de cuidados intensivos, estancias hospitalarias más largas y duración de la ventilación mecánica, otros no lograron establecer tales asociaciones [27][28][29][30] . Sorprendentemente, algunos estudios informaron incluso una relación positiva entre la presencia de ANA y mejores desenlaces clínicos, en especial en términos de parámetros de laboratorio asociados con una intensa actividad del sistema inmunitario y un estado protrombótico 17,27 .…”

Effect of serum autoantibodies on the COVID-19 patient’s prognosis

“…Similar to patients infected with other viruses, infected with SARS-CoV-2 show altered autoantibody profiles (Zhou Y. et al, 2020;Peker et al, 2021;Scappaticcio et al, 2021b), such as, antinuclear antibodies, antithyroid antibodies, chromatin proteins, ribosomal proteins, and immunerelated proteins (Bastard et al, 2020;Chang et al, 2021;Ulndreaj et al, 2022). These autoantibodies are closely correlated with the disease severity and the prognosis of COVID-19 patients and may trigger long-COVID-19 symptoms (Pascolini et al, 2021;Stjepanovic et al, 2022;Son et al, 2023).…”

Bulk and Single-Cell RNA Sequencing Elucidate the Etiology of Severe COVID-19

“…It has been suggested that COVID-19 is related to autoimmune diseases, based on traditional biochemical and molecular markers [ 16 ]. Patients with pre-existing inflammatory or autoimmune conditions, such as cancer, obesity, hypertension, cardiovascular disease, type 2 diabetes, or connective tissue disorders, are at a higher risk of fatal outcomes if autoantibodies are present.…”