Central Medical Laboratories, Feldkirch, Austria.
Private University in the Principality of Liechtenstein, Triesen, Principality of Liechtenstein.
JCI Insight. 2024 Oct 22;9(20):e183913. doi: 10.1172/jci.insight.183913.
BACKGROUNDDespite the currently prevailing, milder Omicron variant of COVID-19, older adults remain at elevated risk of hospital admission, critical illness, and death. Loss of efficacy of the immune system, including reduced strength, quality, and durability of antibody responses, may render generalized recommendations on booster vaccinations inadequate. There is a lack of data on the efficacy of antibody levels in older adults and on the utility of vaccination status versus antibody levels as a correlate of protection. It is further unclear whether antibody levels may be used to guide the timing of booster vaccinations in older adults.METHODSWe conducted a prospective multicenter cohort study comprising hospitalized patients with COVID-19. Anti-SARS-CoV-2 spike antibodies were measured on hospital admission. The primary endpoint was in-hospital mortality. Patients were stratified by age, antibody levels, and vaccination status. Multiple logistic regression and Cox regression analyses were conducted.RESULTSIn total, 785 older patients (≥60 years of age [a]) and 367 controls (<60a) were included. After adjusting for confounders, risk of mortality, ICU admission, endotracheal intubation, and oxygen administration was 4.9, 2.6, 6.5, and 2.3 times higher, respectively, if antibody levels were < 1,200 BAU/mL (aOR, 4.92 [95%CI, 2.59-9.34], P < 0.0001; aOR, 2.64 [95%CI, 1.52-4.62], P = 0.0006; aOR, 6.50 [95%CI, 1.48-28.47], P = 0.013; aOR, 2.34 [95%CI, 1.60-3.343], P < 0.0001). Older adults infected with the Omicron variant were approximately 6 times more likely to die if antibody levels were < 1,200 BAU/mL (aOR, 6.3 [95% CI, 2.43-16.40], P = 0.0002).CONCLUSIONAntibody levels were a stronger predictor of in-hospital mortality than vaccination status. Monitoring antibody levels may constitute a better and more direct approach for safeguarding older adults from adverse COVID-19 outcomes.
尽管目前 COVID-19 的流行变体为奥密克戎，老年人仍面临住院、重症和死亡的高风险。免疫系统的效力下降，包括抗体反应的强度、质量和持久性降低，可能使针对加强针的普遍建议不够充分。目前缺乏关于老年人抗体水平的有效性以及疫苗接种状态与抗体水平作为保护相关性的数据。此外，尚不清楚抗体水平是否可用于指导老年人加强针的接种时间。
我们进行了一项前瞻性多中心队列研究，纳入了因 COVID-19 住院的患者。在入院时测量抗 SARS-CoV-2 刺突抗体。主要终点是住院期间的死亡率。根据年龄、抗体水平和疫苗接种状态对患者进行分层。进行了多项逻辑回归和 Cox 回归分析。
共纳入 785 名老年患者（≥60 岁[a]）和 367 名对照（<60a）。在调整混杂因素后，如果抗体水平<1200 BAU/mL，则死亡率、入住 ICU、气管插管和吸氧的风险分别增加 4.9、2.6、6.5 和 2.3 倍（优势比，4.92[95%置信区间，2.59-9.34]，P<0.0001；优势比，2.64[95%置信区间，1.52-4.62]，P=0.0006；优势比，6.50[95%置信区间，1.48-28.47]，P=0.013；优势比，2.34[95%置信区间，1.60-3.343]，P<0.0001）。如果抗体水平<1200 BAU/mL，感染奥密克戎变异株的老年患者死亡的可能性增加约 6 倍（优势比，6.3[95%置信区间，2.43-16.40]，P=0.0002）。
抗体水平是住院死亡率的更强预测因素，而疫苗接种状态则不然。监测抗体水平可能是保护老年人免受 COVID-19 不良后果的更好和更直接的方法。
