Factors associated with SARS-CoV-2 antibody titers and prognosis of breakthrough infection in hemodialysis patients

Abstract

Background The mortality rate of Coronavirus disease 2019 (COVID-19) is extremely high in hemodialysis patients (HDP). These patients also develop lower antibody titers after vaccination. Therefore, factors associated with antibody titers and vaccine efficacy in HDP with breakthrough infection need to be investigated. Methods We measured anti-S1 antibody titers in HDP (n = 104) and controls (n = 35), evaluating the influence of background on HDP by multivariable regression analysis. We classified 26 HDP patients admitted with COVID-19 into the unvaccinated (n = 15) and breakthrough infection group (n = 11), performing between-group comparisons of laboratory findings and prognosis. Vaccinated COVID-19 patients were classified into HDP and non-HDP controls, and compared the relationship between antibody titer and severity, and the prognosis of breakthrough infection. ResultsThe antibody titer was significantly lower in the HDP group than in the control group. Among HDP, age and smoking history were significantly independent factors associated with antibody titer. The breakthrough infection group had significantly better laboratory findings (KL-6 and LDH), severity, and hospitalization period than the unvaccinated group even if antibody titers were lower than the known threshold for neutralization (p < 0.05). There was no significant difference in prognosis between the HDP and non-HDP with breakthrough infection. Severity of COVID-19 tended to be higher with lower antibody titer in non-HDP, but not in HDP. Conclusion Vaccines improved the severity of COVID-19 and hospitalization period of breakthrough infection in HDP, although HDP, especially in elderly smokers had lower antibody titers than control. There was no significant association between antibody titer and severity in HDP.

Investigation of Possible Factors Influencing the Neutralizing Anti-SARS-CoV-2 Antibody Titer after Six Months from the Second Vaccination Dose in a Sample of Italian Nursing Home Personnel

“…It is now known that these antibodies only represent a component of the immune response, and that the direct role of memory T cells in killing virus-infected cells is equally fundamental [ 7 ]. Nevertheless, the presence of neutralizing antibodies against SARS-CoV-2 is still an important indicator used to determine whether a subject might have a positive response to the vaccine, and their presence is also evaluated in some studies aimed at exploring possible associations with COVID-19 symptoms and prognosis [ 1 , 2 , 3 , 4 , 5 , 6 , 8 , 9 ]. The main target of the anti-SARS-CoV-2 neutralizing antibodies investigated after the performance of the vaccination is the spike (S) protein, and in particular its Receptor-binding Domain (RBD) [ 10 ].…”

Reduced Risk of Progression from Non-Severe to Severe COVID-19 in Hospitalized Dialysis Patients by Full COVID-19 Vaccination

“…However, studies regarding the association of such vaccination with severe COVID-19 progression in dialysis patients are limited. Toda et al reported that full vaccination status was associated with reduced disease severity, including severe COVID-19, in dialysis patients, though the number of cases investigated was small ( n = 26) and the association was not adjusted using known risk factors [ 11 ]. In another study, Ashby et al noted that full vaccination status reduced the need for intubation, shown to correspond to severe COVID-19, in dialysis patients after adjustment for known risk factors including age and diabetes, though the difference was not significant [ 12 ].…”

“…Vaccination began sequentially in February 2021 for healthcare workers, then in June 2021 for individuals with underlying medical conditions, including dialysis patients, with public and private sectors working together to promote vaccination. Although the immune response to such vaccine treatment has been reported to be compromised in dialysis patients [ 9 , 10 , 11 ], vaccination has also been shown to reduce the rate of non-severe COVID-19 cases as well as COVID-19-related mortality in patients receiving that treatment [ 12 , 13 , 14 , 15 , 16 , 17 ]. However, few studies have assessed a dialysis patient cohort regarding the relationship of vaccination with the progression to severe COVID-19.…”

The effect of SARS-CoV-2 double vaccination on the outcomes of hemodialysis patients with COVID-19: A meta-analysis

“…Our search strategy identified a total of 6 studies 8 , 9 , 10 , 11 , 12 , 13 . involving 6244 adult patients with COVID-19, including 3744 in the unvaccinated group and 1921 in the two-dose vaccination group, were included in this meta-analysis.…”