BACKGROUND During the peak of the coronavirus diseases 2019(COVID-19)pandemic,clinicians actively studied the utility of various epidemiologic-clinical parameters to determine the prognosis for patients hospitalized w...BACKGROUND During the peak of the coronavirus diseases 2019(COVID-19)pandemic,clinicians actively studied the utility of various epidemiologic-clinical parameters to determine the prognosis for patients hospitalized with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.Serum IgG antibody level,DDimer,C-reactive protein and neutrophil to lymphocyte ratio,etc.were studied to assess their association with the clinical course in hospitalized patients and predict who may be at increased risk for poor clinical outcome.However,the influence of SARS-CoV-2-anti-nucleocapsid-IgG antibody(IgG-N)sero-positivity on the clinical outcome of patients with COVID-19 is largely unknown.AIM To study the influence of SARS-CoV-2 anti-nucleocapsid-IgG seropositivity on clinical course and diseases severity in hospitalized COVID-19 patients.METHODS We conducted a retrospective study of adults admitted to a tertiary care community hospital in North Dakota with COVID-19.Included patients had severeCOVID-19 disease or worse and so required supplemental oxygen on admission.They were serologically tested for SARS-CoV-2-anti-nuceocapsid-IgG(IgG-N).The IgG-N positive group were 26 patients and the IgG-N negative group had 33 patients.The groups received similar treatment for COVID-19 as approved by our healthcare system from Day 1 of admission until discharge or death.Measurable parameters for monitoring the patients’clinical course included the following:Length of hospitalization(LOS),use of high flow nasal canula(HFNC),use of noninvasive bilevel positive pressure ventilation(BiPAP),admission into the intensive care unit,need for mechanical ventilation(VENT);and the patient outcome/discharge or death.Other variables included were age,gender and body-mass-index,and duration of symptoms before presentation.For each variable,the outcome was modeled as a function of SARS-CoV-2-IgG-N status(positive or negative)using a generalized linear model.For LOS-days,a negative binomial distribution was used as it had a better fit than a Poisson or Gaussian distribution as evidenced by a Pearson chi-square/df value closer to 1.0.All other outcomes utilized a binary logistic regression model.RESULTS After a thorough examination of patient data,it was found that admission rates to the Intensive Care Unit,as well as the usage of BiPAP,HFNC and VENT support,in conjunction with patient outcomes,were not significantly different across IgG-N status.However,the LOS variable when assessed by IgG-N status was found to be significant(t value=2.16,P value=0.0349).IgG-N negative patients had higher than average LOS in comparison to IgG-N positive patients(15.12 vs 9.35 d).Even when removing the extreme value(an LOS of 158 d),IgG-N negative patients still had slightly higher than average stays(10.66 vs 9.35 d)but the relationship was no longer significant.For patient outcome/death,only age(numerical)was a significant predictor(F value=4.66,P value=0.0352).No other variables for any of the outcomes were significant predictors of clinical course or disease severity.CONCLUSION Our study demonstrated that IgG-N seroconversion had no significant association with clinical outcomes in hospitalized COVID-19 patients.展开更多
基金the National Institute of General Medical Sciences of the National Institutes of Health under Award,No.U54GM128729.
文摘BACKGROUND During the peak of the coronavirus diseases 2019(COVID-19)pandemic,clinicians actively studied the utility of various epidemiologic-clinical parameters to determine the prognosis for patients hospitalized with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.Serum IgG antibody level,DDimer,C-reactive protein and neutrophil to lymphocyte ratio,etc.were studied to assess their association with the clinical course in hospitalized patients and predict who may be at increased risk for poor clinical outcome.However,the influence of SARS-CoV-2-anti-nucleocapsid-IgG antibody(IgG-N)sero-positivity on the clinical outcome of patients with COVID-19 is largely unknown.AIM To study the influence of SARS-CoV-2 anti-nucleocapsid-IgG seropositivity on clinical course and diseases severity in hospitalized COVID-19 patients.METHODS We conducted a retrospective study of adults admitted to a tertiary care community hospital in North Dakota with COVID-19.Included patients had severeCOVID-19 disease or worse and so required supplemental oxygen on admission.They were serologically tested for SARS-CoV-2-anti-nuceocapsid-IgG(IgG-N).The IgG-N positive group were 26 patients and the IgG-N negative group had 33 patients.The groups received similar treatment for COVID-19 as approved by our healthcare system from Day 1 of admission until discharge or death.Measurable parameters for monitoring the patients’clinical course included the following:Length of hospitalization(LOS),use of high flow nasal canula(HFNC),use of noninvasive bilevel positive pressure ventilation(BiPAP),admission into the intensive care unit,need for mechanical ventilation(VENT);and the patient outcome/discharge or death.Other variables included were age,gender and body-mass-index,and duration of symptoms before presentation.For each variable,the outcome was modeled as a function of SARS-CoV-2-IgG-N status(positive or negative)using a generalized linear model.For LOS-days,a negative binomial distribution was used as it had a better fit than a Poisson or Gaussian distribution as evidenced by a Pearson chi-square/df value closer to 1.0.All other outcomes utilized a binary logistic regression model.RESULTS After a thorough examination of patient data,it was found that admission rates to the Intensive Care Unit,as well as the usage of BiPAP,HFNC and VENT support,in conjunction with patient outcomes,were not significantly different across IgG-N status.However,the LOS variable when assessed by IgG-N status was found to be significant(t value=2.16,P value=0.0349).IgG-N negative patients had higher than average LOS in comparison to IgG-N positive patients(15.12 vs 9.35 d).Even when removing the extreme value(an LOS of 158 d),IgG-N negative patients still had slightly higher than average stays(10.66 vs 9.35 d)but the relationship was no longer significant.For patient outcome/death,only age(numerical)was a significant predictor(F value=4.66,P value=0.0352).No other variables for any of the outcomes were significant predictors of clinical course or disease severity.CONCLUSION Our study demonstrated that IgG-N seroconversion had no significant association with clinical outcomes in hospitalized COVID-19 patients.
