Journal of General Internal Medicine
BACKGROUND: The SAR-CoV-2 pandemic continues to negatively impact the healthcare system globally with over 800,000 deaths in the United States and millions more worldwide. The cases are rising despite availability of vaccines. For most immunocompetent patients these vaccines will generate a humoral response and also a memory T-cell response. Few if any studies have reported data that measure anti-spike IgG titers and also correlate those titers with clinical outcomes in the instance of breakthrough infection.
METHODS: We conducted a pilot prospective observational clinical study enrolling 30 immunocompetent patients who were admitted with a positive SARS-CoV-2 PCR. Leftover blood from admission was used to obtain antispike and anti-nucleocapsid antibody levels. Baseline characteristics were collected and patients were divided into two categories based on anti-spike antibody level and vaccination status. Clinical outcomes including mortality, major adverse cardiac events (MACE), overall length of stay (LOS), ICU LOS, maximum oxygen support needs, and mechanical ventilation needs were analyzed on day 28 in both categories. RESULTS: On analyzing the patients enrolled, the median age was 59 years, 56.67% were female and 73.3% were Caucasian. 6 patients (20%) were asymptomatic, and 63.3% patients had hypertension. Among all patients, the median duration of symptoms was 7 days, and the median LOS was 7 days as well.Anti-spike antibodywas detected in 22 patients (73.33%), and the median value was 956. Anti-nucleocapsid antibody was positive only in 9 patients (30%). Three patients (10%) were admitted to ICU, and all 3 were mechanically ventilated. Four patients (13.33%) had a MACE event in those 28 days, and 5 patients (16.67%) died. Comparing vaccinated vs unvaccinated: 3/5 deceased patients were unvaccinated, and 2/3 mechanically ventilated were unvaccinated as well but these were not statistically significant. 0.6% patients were asymptomatic in unvaccinated group versus 33% in the vaccinated group. Among the 7 patients with high oxygen needs (fio2 100%), 5 had undetectable anti-spike antibodies, and one had low value (89.6). 2 out of 3 mechanically ventilated and 3 out of 5 deceased patients had undetectable anti-spike antibodies. CONCLUSIONS: Our pilot study did not show significance in outcomes between vaccinated and unvaccinated patients, but this relation has been verified in multiple larger studies. We also noted patients with undetectable/ low anti- spike antibody levels had increased fio2 needs, ICU admission, and mortality.However, it was not feasible to compare both these findings between groups due to less number of patients. This demands a larger study to better describe these relations.
Ghimire B, Thapa B, Aggarwal N, Madanat L, Sager M, O'Connor D, et al. [Halalau A]. Impact of serum IGG levels against SARS-COV-2 on clinical outcomes for hospitalized COVID patients. J Gen Intern Med. 2022 Jun;37(2 Suppl):S287-S288.