Department of Medicine I-Nephrology, Transplantation & Medical Intensive Care, Medical Center Cologne-Merheim, University Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany.
Nephrologisches Zentrum Ibbenbüren, Gravenhorsterstr. 1, 49477, Ibbenbüren, Germany.
Int Urol Nephrol. 2022 Aug;54(8):1939-1945. doi: 10.1007/s11255-021-03076-2. Epub 2021 Dec 3.
The predictive value of antibody titers after the first SARS-CoV-2 vaccination and long-term trajectories of antibody titers in hemodialysis patients are unknown.
SARS-CoV-2 IgG antibodies and their neutralizing effect six weeks after the first and second vaccination were analysed in 30 hemodialysis patients. IgG titers served to classify participants as responders or non-responders and to calculate sensitivity, specificity, and accuracy. Associations between potential risk factors and post-vaccine non-response were analysed by Mann-Whitney-U test and Chi-Squared test. Long-term follow-up analysis (ANOVA) on the evolution of neutralizing IgG-titers was performed in 24 participants 94 and 135 days after the second immunization.
IgG antibodies ≥ 1 AU/L (mean 9 ± 20 AU/L) after the first dose were found in 20 patients (66.7%). After the second dose only two participants (6.7%) remained sero-negative and 16.6% showed neutralizing levels below 30%, whereas 25 patients showed IgG antibodies with the high neutralizing activity of 86 ± 18%. Positive IgG antibodies 6 weeks after the first vaccination predicted vaccination effectiveness after two cycles with a specificity of 100%, sensitivity of 76%, and accuracy of 87%. Even low-dose immunosuppressive therapy increased the relative risk for non-response after the first and second dose 1.9 (95% CI 0.8-4.6) and 4.9 (95% CI 1.0-23.8) times, respectively. Over a period of about 4.5 months IgG titers slowly declined by 51% from baseline or by 0.45 AU/mL per day, respectively.
Two cycles of SARS-CoV-2 vaccination-induced high seroconversion rates comparable to the general population. Immunosuppressive medication is a major risk factor for vaccination non-response. Mounted IgG antibodies showed a high neutralizing capacity as evidence of protective effectiveness. IgG antibodies after the first dose may serve to predict later vaccination outcome. Patients on dialysis display a more rapid decline in antibody titers on long-term follow-up compared to healthy controls.
首次接种 SARS-CoV-2 疫苗后抗体滴度的预测价值以及血液透析患者抗体滴度的长期变化轨迹尚不清楚。
分析了 30 名血液透析患者在首次和第二次接种后 6 周 SARS-CoV-2 IgG 抗体及其中和效果。使用 IgG 滴度将参与者分为应答者和非应答者，并计算敏感性、特异性和准确性。使用 Mann-Whitney-U 检验和卡方检验分析潜在危险因素与疫苗接种后无应答之间的相关性。对 24 名参与者在第二次免疫接种后 94 天和 135 天进行了中和 IgG 滴度演变的长期随访分析（方差分析）。
首次剂量后发现 IgG 抗体≥1 AU/L（平均 9±20 AU/L）的患者有 20 例（66.7%）。第二次剂量后，仅有 2 名患者（6.7%）仍为血清阴性，16.6%的患者中和滴度低于 30%，而 25 名患者的 IgG 抗体具有 86±18%的高中和活性。首次接种后 6 周的阳性 IgG 抗体可预测两轮接种后的疫苗接种效果，特异性为 100%，敏感性为 76%，准确性为 87%。即使低剂量免疫抑制治疗也分别使首次和第二次剂量后的无应答相对风险增加 1.9（95%CI 0.8-4.6）和 4.9（95%CI 1.0-23.8）倍。大约 4.5 个月的时间内，IgG 滴度从基线下降了 51%或每天下降 0.45 AU/mL。
两轮 SARS-CoV-2 疫苗接种可诱导高血清转化率，与一般人群相当。免疫抑制药物是疫苗接种无应答的主要危险因素。产生的 IgG 抗体具有高中和能力，表明具有保护效力。首次剂量后的 IgG 抗体可能有助于预测后续的疫苗接种结果。与健康对照组相比，长期随访中血液透析患者的抗体滴度下降更快。
