Araújo F C, Amaral A C D, Silva H J, Santos J N V, Mendonça V A, Oliveira V C de, Rocha-Vieira E
Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Biologia do Exercício e Imunometabolismo, Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brasil.
Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Laboratório de Inflamação e Metabolismo, Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brasil.
Braz J Med Biol Res. 2025 Jan 31;58:e13965. doi: 10.1590/1414-431X2024e13965. eCollection 2025.
This systematic review of inception prospective cohort studies aimed to investigate whether autoantibodies are potential prognostic factors for short- and long-term clinical outcomes of COVID-19. Searches were conducted in MEDLINE, EMBASE, AMED, GLOBAL HEALTH, and COCHRANE databases from 2019 to 2022. When possible, meta-analysis was conducted, otherwise findings from individual studies were reported using odds ratios (OR) with 95% confidence intervals (CI). Quality of evidence was summarized using the GRADE criteria. We identified 2292 references, 18 inception prospective cohort studies (3178 patients) were included in the systematic review, and 12 studies reached criteria for meta-analysis. Studies achieved, in general, low to moderate risk of bias. Moderate quality of evidence showed that anti-interferon (IFN) was associated with increased risk of severity (OR=7.75; CI=1.79-33.61) and mechanical ventilation (OR=4.19; CI=2.06-8.53), but not with COVID-19 mortality (OR=1.68; CI=0.63-4.44). Antiphospholipids were not associated with COVID-19 mortality (OR=1.42; CI=0.85-2.37; P=0.18; I2=3.21) nor with thrombosis risk (OR=1.41; CI: 0.71-2.8; P=0.33). Antinuclear antibody level was not associated with risk of mortality or severity (risk for mortality: OR=3.8; CI=0.78-18.6; P=0.1; I2: 32.3; severity: OR=1.74; CI=0.96-3.16; P=0.07). Evidence currently available is insufficient for a quantitative analysis of autoantibodies association with long COVID-19. Anti-IFN measurement should be considered in COVID-19 follow-up. In a population-based rational, optimized vaccination strategies should be considered for individuals with anti-IFN antibodies since it could represent a risk for a worse prognosis. High-quality prospective studies for short- and long-term disease effects and autoantibody evaluation are still needed.
这项对起始前瞻性队列研究的系统评价旨在调查自身抗体是否为新冠病毒病（COVID-19）短期和长期临床结局的潜在预后因素。于2019年至2022年在MEDLINE、EMBASE、AMED、全球卫生和考克兰数据库中进行检索。若有可能，进行荟萃分析，否则使用比值比（OR）及95%置信区间（CI）报告个体研究的结果。采用GRADE标准总结证据质量。我们识别出2292篇参考文献，18项起始前瞻性队列研究（3178例患者）纳入系统评价，12项研究达到荟萃分析标准。研究总体上存在低至中度偏倚风险。中等质量的证据表明，抗干扰素（IFN）与病情严重程度增加风险（OR=7.75；CI=1.79 - 33.61）及机械通气风险（OR=4.19；CI=2.06 - 8.53）相关，但与COVID-19死亡率无关（OR=1.68；CI=0.63 - 4.44）。抗磷脂抗体与COVID-19死亡率（OR=1.42；CI=0.85 - 2.37；P=0.18；I²=3.21）及血栓形成风险均无关（OR=1.41；CI：0.71 - 2.8；P=0.33）。抗核抗体水平与死亡风险或病情严重程度均无关（死亡风险：OR=3.8；CI=0.78 - 18.6；P=0.1；I²：32.3；病情严重程度：OR=1.74；CI=0.96 - 3.16；P=0.07）。目前可得的证据不足以对自身抗体与长期COVID-19的关联进行定量分析。在COVID-19随访中应考虑检测抗IFN。基于人群的合理考量，对于具有抗IFN抗体的个体应考虑优化的疫苗接种策略，因为这可能预示预后较差。仍需要针对疾病短期和长期影响以及自身抗体评估的高质量前瞻性研究。
