Mabrey F Linzee, Zelnick Leila R, Morrell Eric D, O'Connor Nicholas G, Hart Andrew, Wurfel Mark M, Liles W Conrad, Bhatraju Pavan K
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA.
Kidney Research Institute (KRI), Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA.
Crit Care Explor. 2022 Aug 29;4(9):e0754. doi: 10.1097/CCE.0000000000000754. eCollection 2022 Sep.
UNLABELLED: To determine whether the early serologic response in COVID-19 critical illness is associated with hospital mortality. To evaluate if time-to-seroconversion differs by receipt of dexamethasone therapy. DESIGN: Patients were prospectively enrolled within 24 hours of ICU admission from two University of Washington Hospitals. Plasma was collected on enrollment and on days 3, 7, 10, and 14. SETTING: ICUs between March 2020 and April 2021. PATIENTS: Consecutive adults with COVID-19 admitted to an ICU. MEASUREMENTS AND MAIN RESULTS: We measured longitudinal total antispike protein antibody levels (anti-S abs) and total antinucleocapsid antibody levels (anti-N ab) using a U.S. Food and Drug Administration-authorized Roche instrument. We evaluated whether detectable anti-S abs on ICU admission were associated with host factors, initial disease severity, and hospital mortality. We evaluated whether dexamethasone therapy was associated with time-to-seroconversion. Among 93 unvaccinated participants, 47 (51%) had detectable anti-S abs on ICU admission. There was no difference in Acute Physiology and Chronic Health Evaluation II score or time between first positive severe acute respiratory syndrome coronavirus-2 PCR and ICU admission in those with detectable versus undetectable anti-S abs. Adjusting for age, body mass index, and sex, patients with detectable anti-S abs had a lower risk of inhospital death (hazard ratio, 0.40; 95% CI, 0.17-0.94; = 0.04). Among 21 patients with undetectable anti-S abs on ICU admission and serial measurements available, time-to-seroconversion was not significantly affected by receipt of dexamethasone therapy. CONCLUSIONS: In COVID-19 critical illness, a significant proportion of patients do not have detectable antibodies at ICU admission, and this is independent of severity of illness. Detectable anti-S abs were associated with lower risk of inhospital death. Despite concern that corticosteroids may impair an appropriate antiviral serologic response, early antibody kinetics were not significantly affected by administration of dexamethasone; however, CIs were wide and require further study.
未标注：确定新冠危重症患者的早期血清学反应是否与医院死亡率相关。评估血清转化时间是否因接受地塞米松治疗而有所不同。 设计：患者在入住华盛顿大学两所医院重症监护病房（ICU）的24小时内被前瞻性纳入研究。在入组时以及第3、7、10和14天采集血浆。 背景：2020年3月至2021年4月期间的ICU。 患者：连续入住ICU的成年新冠患者。 测量指标及主要结果：我们使用美国食品药品监督管理局授权的罗氏仪器测量纵向总抗刺突蛋白抗体水平（抗S抗体）和总抗核衣壳抗体水平（抗N抗体）。我们评估了入住ICU时可检测到的抗S抗体是否与宿主因素、初始疾病严重程度和医院死亡率相关。我们评估了地塞米松治疗是否与血清转化时间相关。在93名未接种疫苗的参与者中，47名（51%）在入住ICU时可检测到抗S抗体。在抗S抗体可检测与不可检测的患者中，急性生理与慢性健康状况评分II或首次严重急性呼吸综合征冠状病毒2聚合酶链反应阳性与入住ICU之间的时间无差异。在调整年龄、体重指数和性别后，抗S抗体可检测的患者院内死亡风险较低（风险比，0.40；95%置信区间，0.17 - 0.94；P = 0.04）。在21名入住ICU时抗S抗体不可检测且有系列测量数据的患者中，血清转化时间未受地塞米松治疗的显著影响。 结论：在新冠危重症中，相当一部分患者在入住ICU时没有可检测到的抗体，且这与疾病严重程度无关。可检测到的抗S抗体与较低的院内死亡风险相关。尽管担心皮质类固醇可能会损害适当的抗病毒血清学反应，但早期抗体动力学未受地塞米松给药的显著影响；然而，置信区间较宽，需要进一步研究。
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