SARS-CoV-2 viral loads and serum IgA/IgG immune responses in critically ill COVID-19 patients
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LETTER
SARS‑CoV‑2 viral loads and serum IgA/IgG immune responses in critically ill COVID‑19 patients Slim Fourati1,2,3, Sophie Hue2,4,5,6, Jean‑Michel Pawlotsky1,2,3, Armand Mekontso‑Dessap2,7,8 and Nicolas de Prost2,7,8,9* © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Dear Editor The pandemic of coronavirus disease 2019 (COVID19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents the greatest global public health crisis that occurred during the last decades. Among hospitalized patients, up to 25% will develop acute respiratory failure and the acute respiratory distress syndrome (ARDS) and require intensive care unit (ICU) admission. The median duration between onset of symptoms and ICU admission ranges from 7 to 12 days [1], suggesting a gradual deterioration in the majority of cases. Although the clinical characteristics of patients requiring ICU admission have now been well described [2–4], their viro-immunological features are still unknown. Whether a higher titer of SARS-CoV2-specific antibodies may reduce viral RNA load in upper respiratory samples and eventually mitigate the course of infection in patients admitted in the ICU has not been established. We examined the relationship between SARS-CoV-2 viral loads collected from nasopharyngeal swabs on ICU admission, concomitant SARS-CoV-2-specific IgA and IgG antibody titers, and day-28 mortality. This is a prospective monocenter study, which included all patients diagnosed with RT-PCR-confirmed SARSCoV-2 infection consecutively admitted in the medical ICU at Henri Mondor Hospital, Créteil, France, between March 8, 2020, and March 26, 2020. The study has received the approbation of an institutional review *Correspondence: nicolas.de‑[email protected] 9 Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Créteil, France Full author information is available at the end of the article Slim Fourati and Sophie Hue have contributed equally to this work.
board (Comité de Protection des Personnes Ile de France II; reference number: 3675-NI). Informed consent was obtained from all patients or their relatives. Nasopharyngeal swabs and sera were collected from patients within 48 h of ICU admission. The cycle threshold values of RTPCR were used as indicators of the viral load of SARSCoV-2 RNA in nasopharyngeal specimens, with lower cycle threshold values corresponding to higher viral load. IgA and IgG antibodies against SARS-CoV-2 spike protein subunit 1 (S1) were quantified in patients’ serum using ELISAs (Euroimmun Medizinische Labordiagnostika, Lübeck, Germany) and expressed in arbitrary units (AU). The primary clinical outcome was day-28 mortality. Twenty-five patients [mean age 60 ± 14 years; males 80% (n = 20/25)] were admitted in the ICU for severe SARS-CoV-2 infection during the study period. The median time elapsed between the first symptoms and ICU admission was 9 days [6–12]. Invasive mechanical ventilation was required in 96% (n = 24/25) of patients during ICU stay, and the mortality at day-2
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