Hu Zhiquan, Li Jingjing, Yang Chunguang, Chen Fen, Wang Zhihua, Lei Ping, Shen Guanxin
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Int J Gen Med. 2021 Dec 29;14:10429-10438. doi: 10.2147/IJGM.S322971. eCollection 2021.
COVID-19 outbreak began in Wuhan and pandemics occur. Although SARS-CoV-2-specific immunoglobulins have been detected in serum of COVID-19 patients, their dynamics and association with outcomes have not been fully characterized.
This retrospective cohort study investigated the association between SARS-CoV-2-specific immunoglobulins and clinical outcomes of COVID-19 patients. We recruited 137 participants who were diagnosed with COVID-19 in four wards of the Tongji Hospital in Wuhan, China. Among the 137 participants, 81 patients were recovered, 23 patients died, and 33 patients remained hospitalized by the end of the study. SARS-CoV-2-specific immunoglobulins were analyzed by chemiluminescence assays. Laboratory and radiological characteristics, and clinical outcomes were compared between the recovered group and the deceased group. Furthermore, a matched cohort study was conducted in which each non-survivor was matched to two recovered patients of similar age.
SARS-CoV-2-specific IgM levels peaked in the fourth week after the onset of COVID-19, while serum IgG levels rose earlier and remained high up to the eighth week. In the age-matched cohort study, the serum IgM, but not IgG levels, were higher among the non-survivors than in the recovered group (P = 0.006). The area under the ROC curve for the IgM and IgG levels was 0.702 (95% CI: 0.560-0.845, P = 0.006) and 0.596 (95% confidence interval: 0.449-0.744, P = 0.194), respectively. We also showed that patients with COVID-19 who had high IgM or IgG levels (stratified according to best cut-off) exhibited significantly lower overall survival (Kaplan-Meier survival curves, P < 0.05).
These results indicate the association between immunoglobulins and outcome in patients with COVID-19 and demonstrated that elevated serum IgM levels could indicate poor outcomes in patients with COVID-19. Further, the information about the profile of SARS-CoV-2-specific IgGs may be useful for the future epidemiological investigations of COVID-19 therapies.
新冠疫情始于武汉并蔓延成全球大流行。尽管在新冠患者血清中已检测到针对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的特异性免疫球蛋白，但其动态变化及其与临床结局的关联尚未完全明确。
这项回顾性队列研究调查了SARS-CoV-2特异性免疫球蛋白与新冠患者临床结局之间的关联。我们招募了在中国武汉同济医院四个病区被诊断为新冠的137名参与者。在这137名参与者中，81名患者康复，23名患者死亡，33名患者在研究结束时仍住院治疗。采用化学发光法分析SARS-CoV-2特异性免疫球蛋白。比较康复组和死亡组的实验室及影像学特征以及临床结局。此外，进行了一项匹配队列研究，将每名非幸存者与两名年龄相仿的康复患者进行匹配。
SARS-CoV-2特异性IgM水平在新冠发病后第四周达到峰值，而血清IgG水平上升更早且直至第八周仍维持在较高水平。在年龄匹配队列研究中，非幸存者血清IgM水平高于康复组，而IgG水平则无差异（P = 0.006）。IgM和IgG水平的ROC曲线下面积分别为0.702（95%CI：0.560 - 0.845，P = 0.006）和0.596（95%置信区间：0.449 - 0.744，P = 0.194）。我们还发现，IgM或IgG水平高的新冠患者（根据最佳截断值分层）总体生存率显著较低（Kaplan-Meier生存曲线，P < 0.05）。
这些结果表明了免疫球蛋白与新冠患者临床结局之间的关联，并证明血清IgM水平升高可能预示新冠患者预后不良。此外，SARS-CoV-2特异性IgG的特征信息可能对未来新冠治疗的流行病学调查有用。
