Critically Ill COVID-19 Patients Exhibit Anti-SARS-CoV-2 Serological Responses

Abstract

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is a global health care emergency. Anti-SARS-CoV-2 serological profiling of critically ill COVID-19 patients was performed to determine their humoral response. Blood was collected from critically ill ICU patients, either COVID-19 positive (+) or COVID-19 negative (−), to measure anti-SARS-CoV-2 immunoglobulins: IgM; IgA; IgG; and Total Ig (combined IgM/IgA/IgG). Cohorts were similar, with the exception that COVID-19+ patients had a greater body mass indexes, developed bilateral pneumonias more frequently and suffered increased hypoxia when compared to COVID-19- patients (p < 0.05). The mortality rate for COVID-19+ patients was 50%. COVID-19 status could be determined by anti-SARS-CoV-2 serological responses with excellent classification accuracies on ICU day 1 (89%); ICU day 3 (96%); and ICU days 7 and 10 (100%). The importance of each Ig isotype for determining COVID-19 status on combined ICU days 1 and 3 was: Total Ig, 43%; IgM, 27%; IgA, 24% and IgG, 6%. Peak serological responses for each Ig isotype occurred on different ICU days (IgM day 13 > IgA day 17 > IgG persistently increased), with the Total Ig peaking at approximately ICU day 18. Those COVID-19+ patients who died had earlier or similar peaks in IgA and Total Ig in their ICU stay when compared to patients who survived (p < 0.005). Critically ill COVID-19 patients exhibit anti-SARS-CoV-2 serological responses, including those COVID-19 patients who ultimately died, suggesting that blunted serological responses did not contribute to mortality. Serological profiling of critically ill COVID-19 patients may aid disease surveillance, patient cohorting and help guide antibody therapies such as convalescent plasma.

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“…23. Other studies have also reported the delayed B cell responses in Severe COVID-19 patients [19,21,23,24]. 24.…”

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“…Fraser et.al found that COVID-19+ patients who died had earlier/similar peaks in IgA and total Ig in their ICU stay when compared with the patients who have survived [24]. Critically ill COVID-19 patients exhibit anti-SARS-CoV-2 serological responses, including those COVID-19 patients who ultimately died, suggesting that blunted serological responses did not contribute to mortality [24].…”

“…COVID-19 has been associated with hyper inflammation [10][11][12][13][14][15][16][17][18] and delayed humoral immune respo--nses [19,20,21,22,23,24]. Most of the complications with COVID-19 patients have been associated with early hypoxia, ARDS, pneumonia [60,77, [35][36][37][38][39] and Acute Lung Injury [30][31][32][33][34].…”

“…Fraser et.al reported that Peak serological responses for each Ig isotype occurred on different ICU days (IgM day 13 >IgA day 17 > IgG persistently increased), with the total Ig peaking at approximately ICU day 18 [24]. Fraser et.al found that COVID-19+ patients who died had earlier/similar peaks in IgA and total Ig in their ICU stay when compared with the patients who have survived [24].…”

“…Fraser et.al reported that Peak serological responses for each Ig isotype occurred on different ICU days (IgM day 13 >IgA day 17 > IgG persistently increased), with the total Ig peaking at approximately ICU day 18 [24]. Fraser et.al found that COVID-19+ patients who died had earlier/similar peaks in IgA and total Ig in their ICU stay when compared with the patients who have survived [24]. Critically ill COVID-19 patients exhibit anti-SARS-CoV-2 serological responses, including those COVID-19 patients who ultimately died, suggesting that blunted serological responses did not contribute to mortality [24].…”