Asian Journal of Transfusion Science
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ORIGINAL ARTICLE  
Ahead of print publication
Humoral response to SARS-COV-2 in COVID-19-recovered patients and correlation with various factors


1 Department of Transfusion Medicine, King George's M.U, Lucknow, Uttar Pradesh, India
2 Department of Medicine, King George's M.U, Lucknow, Uttar Pradesh, India
3 Era Medical College, Lucknow, Uttar Pradesh, India
4 Department of Internal Medicine, King George's M.U, Lucknow, Uttar Pradesh, India

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Date of Submission20-May-2021
Date of Decision09-Jun-2021
Date of Acceptance12-Jun-2021
Date of Web Publication04-Jun-2022
 

   Abstract 

CONTEXT: On exposure to SARS-CoV-2 in participants anti-SARS-CoV-2 antibodies are expected to appear as a humoral response. Furthermore, various factors affect their expression.
AIMS: The aim of this study is to investigate the humoral response of COVID-19-recovered participants and correlation with duration of disease, duration of COVID positive to date of test, occupation, blood group, age group, weight, gender, and symptoms of anti-SARS-CoV-2 antibodies.
SETTINGS AND DESIGN: This prospective observational study was conducted at the Department of Transfusion Medicine, at a tertiary care center in North India.
METHODS: Seventy-two participants were tested for anti-SARS-CoV-2 antibodies on chemiluminescent microparticle immunoassay postgetting COVID negative.
STATISTICAL ANALYSIS: The data were analyzed using Kruskal–Wallis and Mann–Whitney test. To correlate variables such as duration of disease, duration of COVID positive to date of test of immunoglobulin G (IgG), occupation, blood group, weight, gender, symptoms, and age group Chi-square test were used.
RESULTS: The correlation of anti-SARS-CoV-2 antibodies with a duration of disease (P > 0.05), duration of COVID positive to date of test of IgG (P > 0.05), occupation (P > 0.05), blood group (P > 0.05), weight (P > 0.05), gender (P > 0.05), and symptoms (P > 0.05) is insignificant and whereas significant correlation with age group (P < 0.05) seen.
CONCLUSIONS: A significant correlation was seen in anti-SARS-COV-2 antibodies and age group. Higher antibody levels were seen in participants of the upper extreme age group (50–60 years).

Keywords: Anti-SARS-CoV-2, COVID-19, humoral response


How to cite this URL:
Chandra T, Himanshu D, Maurya PK, Agarwal M, Pandey S. Humoral response to SARS-COV-2 in COVID-19-recovered patients and correlation with various factors. Asian J Transfus Sci [Epub ahead of print] [cited 2022 Dec 4]. Available from: https://www.ajts.org/preprintarticle.asp?id=346000



   Introduction Top


In 2019, SARS-CoV-2 was first reported and later declared a pandemic. Quarantine, screening of cases that had symptoms lead to reduced transmission, and early diagnosis and severity will help in epidemic impact.[1],[2],[3] As infection is novel to humans, so screening of the population for antibodies will help in the extent of infection.[4] COVID-19-recovered population expresses anti-SARS-CoV-2 antibodies (immunoglobulin G [IgG] and neutralizing antibodies) usually after 2 weeks of recovery.[5],[6] However, titer of IgG and neutralizing antibodies start to wane after 2–3 months. Prior infection with the other SARS-CoV also showed no long-lasting immune protection.[7],[8]


   Methods Top


This prospective observational study was conducted at the Department of Transfusion Medicine, at a tertiary care center in North India during the COVID pandemic, and the study was conducted over a 6-month duration from April 2020 to September 2020.

Patients who had recovered from COVID were recruited in the study as per the guidelines laid down by the Drug and Cosmetic Act and the Indian Council of Medical Research and were screened for the SARS-CoV-2 antibodies. All participants were screened only after 14 days of being COVID negative or 28 days after being diagnosed COVID positive if COVID-negative report was not available. Some of the participants were screened for the antibodies more than once with a minimum interval of 2 weeks. All the individuals were between the age group of 18–60 years. Only nulliparous female participants were included in the study.

A total of 72 participants tested for COVID IgG on the 15th–29th day after being COVID negative were recruited in the study as a sample. Anti-SARS-COV-2 antibodies were detected using commercially available SARS-COV-2 chemiluminescent microparticle immunoassay, qualitative detection of IgG antibodies to SARS-COV-2 in human serum, and plasma on the ARCHITECT i System. The default result unit for the SARS-CoV-2 IgG assay cutoff was 1.4 index (S/C) so a result more than and equal to 1.4 was taken as positive for IgG antibodies.

The study was approved by the Institutional Ethics Committee before enrollment of the individuals. Participants were recruited after written informed consent.

Statistical analysis

Data were analyzed using the appropriate statistical procedures and SPSS software version-23. Continuous variables were expressed as mean, Kruskal–Wallis, and Mann‒Whitney tests were used for continuous variables and Chi-square tests were used for categorical variables for comparisons between groups. P ≤ 0.05 was considered statistically significant.


   Results Top


Plasma donors tested for COVID IgG on the 15th–29th day after being COVID Negative were 72.

The highest COVID IgG levels (4.71) were seen when the duration from recovery was more than 28 days, whereas the lowest values were seen (4.30) between 8 and 13 days.

The highest COVID IgG levels (4.47) were seen after 1 month to 2 months after being diagnosed as COVID positive, whereas the lowest (4.16) levels were observed between 15 and 29 days [Table 1].
Table 1: Association of OD status with the duration of disease

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Table 2: Association of OD status with the duration of coronavirus disease positive to date of test of IgG

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Nonhealth workers showed the highest levels of antibody (4.66) as compared to students who showed the lowest levels of IgG [Table 3].
Table 3: Association of OD status with the occupation

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Donors with blood group B-positive showed the highest antibody levels, whereas the A-negative blood group had the minimum IgG antibody levels[Table 4].
Table 4: Association of OD status with blood group

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A significant correlation was seen between the age group and plasma IgG levels. It was highest in the age group of 50–60 years and minimum in the young age group of 18–29 years [Table 5].
Table 5: Association of OD status with age group

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The highest IgG levels were seen in donors with a weight of more than 120 kg, while the minimum was seen in donors weighing between 50 and 59 kg [Table 6].
Table 6: Association of OD status with weight

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Males had higher antibody levels as compared to females [Table 7].
Table 7: Association of OD status with gender

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There was no significant correlation between symptoms during COVID and antibody levels [Table 8].
Table 8: Association of antibody levels with symptoms of coronavirus disease

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   Discussion Top


In our study, highest COVID IgG levels (4.71) were seen, when the duration of the disease was more than 28 days, whereas the lowest values were seen (4.30), when the disease lasted between 8 and 13 days. In addition, it was observed that COVID IgG levels were highest when 1 month to 2 months had elapsed after being diagnosed as COVID positive, whereas the lowest IgG levels were observed between 15 and 29 days of COVID diagnosis. In all of the cases, the ideal time for testing for COVID IgG antibodies seemed to be 14 days after recovery. However, anti-N IgG was showing peaks in 7–14 days to test in abbot, but other tests were showing low antibody detection rate and antibody levels with a shorter duration of antibody testing. Naaber et al. concluded that different viral proteins can elicit immune response earlier and at high levels as compared to others.[9] In another study, peak was seen 10–15 days after onset of disease (median = 30; range: 14–78 days).[10]

Association between blood group antigen and viral infections has been noticed previously in a study by Cooling.[11] In our study, the highest mean was 9.15 of COVID IgG with blood group B+. In another study, it had been observed that blood group A is at higher risk of getting infection, whereas O blood group shows a protective effect. Furthermore, higher amounts of antibodies were formed by A blood group patients, but O was the least antibody producer.[10] In our study, B + blood group patients had the highest protective effects and A − were most susceptible. The difference may be due to demographic and epidemiological variables.

No significant correlation with the gender with COVID IgG was seen which correlated with other studies A significant correlation in patient's age group of 50–60 years with the highest level of COVID IgG antibodies was seen in our study which was unlike the study of Naaber et al. where no correlation was seen.[9] In another study, high humoral response was seen with patients who are acutely ill males of the older age group which correlated with our findings.

We also found that higher antibodies were seen with a higher weight of donors. Similar results were reported where patients with a higher weight of more than 90 kg or overweight/obese had a higher titer of antibody.[10]

We did not find a significant correlation between symptoms of COVID or duration of symptoms with antibody levels. In contrast to our study, Naaber et al. said that patients with the higher symptom score had a higher rate of getting positive and high levels of antibody with one specific brand of the antibody testing kit targeting a specific antigen. At the same time, results were insignificant with other antibody testing kits targeting another antigen. However, the conclusion was that symptomatic patients had a better immune response in comparison to the asymptomatic one against the viral protein.[9] In another study, despite no severe symptoms of the disease, patients had shown intensified and prolonged humoral-mediated immune response.


   Conclusions Top


The result of this study has come out with the conclusion that there is a significant association between anti-SARS-COV-2 antibodies and age group. A higher amount of anti-SARS-CoV-2 antibodies were seen in plasma and serum of participants of the upper extreme age group (50–60 years).

Acknowledgment

We will like to acknowledge the technical and paramedical staff of the Department of Transfusion Medicine of KGMU for their hard work which made this study possible.

Financial support and sponsorship

This study was financially supported by KGMU Administration.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Roda WC, Varughese MB, Han D, Li MY. Why is it difficult to accurately predict the COVID-19 epidemic? Infect Dis Model 2020;5:271-81.  Back to cited text no. 1
    
2.
Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: A model-based analysis. Lancet Infect Dis 2020;20:669-77.  Back to cited text no. 2
    
3.
Lipsitch M, Swerdlow DL, Finelli L. Defining the epidemiology of COVID-19-Studies needed. N Engl J Med 2020;382:1194-6.  Back to cited text no. 3
    
4.
WHO, World Health Organization. Population based age stratified seroepidemiological investigation protocol for COVID 19 virus infection. World Heal Organ. 2020. p. 1 19. Available from: https://www.who.int/emergencies/diseases/ novel 20.05.2021.  Back to cited text no. 4
    
5.
Ni L, Ye F, Cheng ML, Feng Y, Deng YQ, Zhao H, et al. Detection of SARS-CoV-2-specific humoral and cellular immunity in COVID-19 convalescent individuals. Immunity 2020;52:971-7.e3.  Back to cited text no. 5
    
6.
Marklund E, Leach S, Axelsson H, Nyström K, Norder H, Bemark M, et al. Serum-IgG responses to SARS-CoV-2 after mild and severe COVID-19 infection and analysis of IgG non-responders. PLoS One 2020;15:e0241104.  Back to cited text no. 6
    
7.
Madewell ZJ, Yang Y, Ira M. Longini Jr., Halloran ME, Dean NE. NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv 2020;1:1-13.  Back to cited text no. 7
    
8.
Liu W, Fontanet A, Zhang PH, Zhan L, Xin ZT, Baril L, et al. Two-year prospective study of the humoral immune response of patients with severe acute respiratory syndrome. J Infect Dis 2006;193:792-5.  Back to cited text no. 8
    
9.
Naaber P, Hunt K, Pesukova J, Haljasmägi L, Rumm P, Peterson P, et al. Evaluation of SARS-CoV-2 IgG antibody response in PCR positive patients: Comparison of nine tests in relation to clinical data. PLoS One 2020;15:e0237548.  Back to cited text no. 9
    
10.
Wendel S, Fontão-Wendel R, Fachini R, Candelaria G, Scuracchio P, Achkar R, Brito M, et al. A longitudinal study of convalescent plasma (CCP) donors and correlation of ABO group, initial neutralizing antibodies (nAb ) and body mass index (BMI) with nAb and anti-nucleocapsid (NP) SARS-CoV-2 antibody kinetics: Proposals for better quality of CCP collections. Transfusion. 2021 M-1460. doi: 10. 1111/trf. 16323. E 2021 F 19. P 33604884; PP. https://orcid.org/0000-0002-1941-7733; Vol. 0. 2020. 20.05.2021..  Back to cited text no. 10
    
11.
Cooling L. Blood groups in infection and host susceptibility. Clin Microbiol Rev 2015;28:801-70.  Back to cited text no. 11
    

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Correspondence Address:
Tulika Chandra,
Department of Transfusion Medicine, King George's M.U, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajts.ajts_56_21




 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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