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Severe Acute Respiratory Syndrome Coronavirus 2 Plasma Antibody and Nucleocapsid Antigen Status Predict Outcomes in Outpatients With Coronavirus Disease 2019

  1. Author:
    Jilg, Nikolaus [ORCID]
    Giganti, Mark J [ORCID]
    Chew, Kara W [ORCID]
    Shaw-Saliba, Katy [ORCID]
    Ritz, Justin [ORCID]
    Moser, Carlee [ORCID]
    Evering, Teresa H
    Daar, Eric S [ORCID]
    Eron, Joseph J
    Currier, Judith S [ORCID]
    Hughes, Michael D
    Lane, H Cliff [ORCID]
    Dewar,Robin [ORCID]
    Smith, Davey M [ORCID]
    Li, Jonathan Z [ORCID]

  2. Author Address

    1Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. 2Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA. 3Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA. 4National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA. 5Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA. 6Division of HIV Medicine, The Lundquist Institute, University of California, Los Angeles Center, Torrance, California, USA. 7Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 8Virus Isolation and Serology Laboratory, Frederick National Laboratory, Frederick, Maryland, USA. 9Division of Infectious Diseases, Department of Medicine, University of California, San Diego, La Jolla, California, USA.
    1. Year: 2024
    2. Date: Jul 17
    3. Epub Date: 2024 07 17
  2. Journal: Clinical Infectious diseases : an official publication of the Infectious Diseases Society of America
  4. Type of Article: Article
  5. Article Number: ciae324
  1. Abstract:

    Reliable biomarkers of coronavirus disease 2019 (COVID-19) outcomes are critically needed. We evaluated associations of spike antibody (Ab) and plasma nucleocapsid antigen (N Ag) with clinical outcomes in nonhospitalized persons with mild-to-moderate COVID-19. Participants were nonhospitalized adults with mild-to-moderate COVID-19 enrolled in ACTIV-2 between January and July 2021 and randomized to placebo. We used quantitative assays for severe acute respiratory syndrome coronavirus 2 spike Ab and N Ag in blood and determined numbers of hospitalization/death events within 28 days and time to symptom improvement. Of 209 participants, 77 (37%) had quantifiable spike Ab and 139 (67%) quantifiable N Ag. Median age was 50 years; 111 (53%) were female, 182 (87%) White, and 105 (50%) Hispanic/Latino. Higher risk of hospitalization/death was seen with unquantifiable (22/132 [16.7%]) versus quantifiable (1/77 [1.3%]) spike Ab (risk ratio [RR], 12.83 [95% confidence interval {CI}, 1.76-93.34]) and quantifiable (22/139 [15.8%]) vs unquantifiable (1/70 [1.4%]) N Ag (RR, 11.08 [95% CI, 1.52-80.51]). Increasing risk of hospitalizations/deaths was seen with increasing N Ag levels. Time to symptom improvement was longer with unquantifiable versus quantifiable spike Ab (median, 14 [interquartile range {IQR}, 8 to >27] vs 8 [IQR, 4-22] days; adjusted hazard ratio [aHR], 0.66 [95% CI, .45-.96]) and with quantifiable versus unquantifiable N Ag (median, 12 [7 to >27] vs 10 [5-22] days; aHR, 0.79 [95% CI, .52-1.21]). Absence of spike Ab and presence of plasma N Ag predicted hospitalization/death and delayed symptom improvement in COVID-19 outpatients. © The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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External Sources

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  2. DOI: 10.1093/cid/ciae324
  3. PMID: 39018444
  4. PII : 7715953

Library Notes

  1. Fiscal Year: FY2023-2024
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