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Batra M, Tian R, Zhang C, Clarence E, Sacher CS, Miranda JN, De La Fuente JRO, Mathew M, Green D, Patel S, Bastidas MVP, Haddadi S, Murthi M, Gonzalez MS, Kambali S, Santos KHM, Asif H, Modarresi F, Faghihi M, Mirsaeidi M. Role of IgG against N-protein of SARS-CoV2 in COVID19 clinical outcomes. Sci Rep 2021; 11:3455. [PMID: 33568776 PMCID: PMC7875990 DOI: 10.1038/s41598-021-83108-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/29/2021] [Indexed: 02/08/2023] Open
Abstract
The Nucleocapsid Protein (N Protein) of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV2) is located in the viral core. Immunoglobulin G (IgG) targeting N protein is detectable in the serum of infected patients. The effect of high titers of IgG against N-protein on clinical outcomes of SARS-CoV2 disease has not been described. We studied 400 RT-PCR confirmed SARS-CoV2 patients to determine independent factors associated with poor outcomes, including Medical Intensive Care Unit (MICU) admission, prolonged MICU stay and hospital admissions, and in-hospital mortality. We also measured serum IgG against the N protein and correlated its concentrations with clinical outcomes. We found that several factors, including Charlson comorbidity Index (CCI), high levels of IL6, and presentation with dyspnea were associated with poor clinical outcomes. It was shown that higher CCI and higher IL6 levels were independently associated with in-hospital mortality. Anti-N protein IgG was detected in the serum of 55 (55%) patients at the time of admission. A high concentration of antibodies, defined as signal to cut off ratio (S/Co) > 1.5 (75 percentile of all measurements), was found in 25 (25%) patients. The multivariable logistic regression models showed that between being an African American, higher CCI, lymphocyte counts, and S/Co ratio > 1.5, only S/Co ratio were independently associated with MICU admission and longer length of stay in hospital. This study recommends that titers of IgG targeting N-protein of SARS-CoV2 at admission is a prognostic factor for the clinical course of disease and should be measured in all patients with SARS-CoV2 infection.
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Affiliation(s)
- Mayank Batra
- Division of Pulmonary and Critical Care, University of Miami, 1600 NW 10th Ave # 7072B, Miami, FL, 33136, USA
| | - Runxia Tian
- Division of Pulmonary and Critical Care, University of Miami, 1600 NW 10th Ave # 7072B, Miami, FL, 33136, USA
| | - Chongxu Zhang
- Division of Pulmonary and Critical Care, University of Miami, 1600 NW 10th Ave # 7072B, Miami, FL, 33136, USA
| | | | | | | | | | - Megan Mathew
- School of Medicine, University of Miami, Miami, FL, USA
| | - Desmond Green
- School of Medicine, University of Miami, Miami, FL, USA
| | - Sayari Patel
- School of Medicine, University of Miami, Miami, FL, USA
| | | | - Sara Haddadi
- Division of Pulmonary and Critical Care, University of Miami, 1600 NW 10th Ave # 7072B, Miami, FL, 33136, USA
| | - Mukunthan Murthi
- Division of Pulmonary and Critical Care, University of Miami, 1600 NW 10th Ave # 7072B, Miami, FL, 33136, USA
| | - Miguel Santiago Gonzalez
- Division of Pulmonary and Critical Care, University of Miami, 1600 NW 10th Ave # 7072B, Miami, FL, 33136, USA
| | - Shweta Kambali
- Division of Pulmonary and Critical Care, University of Miami, 1600 NW 10th Ave # 7072B, Miami, FL, 33136, USA
| | - Kayo H M Santos
- Division of Pulmonary and Critical Care, University of Miami, 1600 NW 10th Ave # 7072B, Miami, FL, 33136, USA
| | - Huda Asif
- Division of Pulmonary and Critical Care, University of Miami, 1600 NW 10th Ave # 7072B, Miami, FL, 33136, USA
| | | | | | - Mehdi Mirsaeidi
- Division of Pulmonary and Critical Care, University of Miami, 1600 NW 10th Ave # 7072B, Miami, FL, 33136, USA.
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