背景:严重急性呼吸道综合症冠状病毒2(SARS-CoV-2)病毒在过去2年中已成为大流行。对病毒的炎症反应导致器官功能障碍和死亡。预测炎症反应的严重程度有助于使用血清学测试IgG和IgM管理危重患者。
目的:研究血清(IgM和IgG)与逆转录聚合酶链反应(RT-PCR)状态的相关性,疾病严重程度[轻度至严重],重症监护病房(ICU)入院,感染性休克,急性肾损伤,和住院死亡率。
方法:我们进行了一项纵向研究,将血清SARS-CoV-2免疫球蛋白M(IgM)和免疫球蛋白G(IgG)血清学与2019年冠状病毒病(COVID-19)患者的临床结果相关联。我们分析了2020年3月至12月在全印度医学科学研究所Rishikesh入院的患者数据。从电子医院门户收集这些患者的临床和实验室数据并进行分析。观察到与临床结果的相关性,并使用MSExcel2010和SPSS软件进行评估。
结果:在494名患者中,患者的平均年龄为48.95±16.40岁,研究中男性患者较多(66.0%).患者被分类为轻度-中度328(67.1%),严重131(26.8%),和临界30(6.1%)。从症状发作到血清学检查的平均持续时间为19.87±30.53d。在25.1%的患者中观察到住院死亡率。血清阳性率(即,IgG或IgM>10AU)为50%。IgM水平(AU/mL)(W=33428.000,P≤0.001)和IgG水平(AU/mL)(W=39256.500,P≤0.001),与中位数IgM/IgG水平(AU/mL),与RT-PCR阴性临床COVID-19相比,RT-PCR阳性组最高。两组在所有其他临床结局(疾病严重程度,感染性休克,入住ICU,机械通气,和死亡率)。
结论:研究表明,与临床COVID-19相比,RT-PCR阳性组的血清学水平较高。然而,血清学无法用于疾病结局的预测。该研究还强调了在特定时间进行血清学的重要性,因为抗体滴度随疾病持续时间而变化。在第3周,临床结果与血清学之间存在显着相关性。
BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has become a pandemic for the last 2 years. Inflammatory response to the virus leads to organ dysfunction and death. Predicting the severity of inflammatory response helps in managing critical patients using serology tests IgG and IgM.
OBJECTIVE: To investigate the correlation of the serology (IgM and IgG) with reverse transcriptase polymerase chain reaction (RT-PCR) status, disease severity [mild to critical], intensive care unit (ICU) admission, septic shock, acute kidney injury, and in-hospital mortality.
METHODS: We conducted a longitudinal study to correlate serum SARS-CoV-2 immunoglobulin M (IgM) and immunoglobulin G (IgG) serology with clinical outcomes in coronavirus disease 2019 (COVID-19) patients. We analyzed patient data from March to December 2020 for those who were admitted at All India Institute of Medical Sciences Rishikesh. Clinical and laboratory data of these patients were collected from the e-hospital portal and analyzed. A correlation was seen with clinical outcomes and was assessed using MS Excel 2010 and SPSS software.
RESULTS: Out of 494 patients, the mean age of patients was 48.95 ± 16.40 years and there were more male patients in the study (66.0%). The patients were classified as mild-moderate 328 (67.1%), severe 131 (26.8%), and critical 30 (6.1%). The mean duration from symptom onset to serology testing was 19.87 ± 30.53 d. In-hospital mortality was observed in 25.1% of patients. The seropositivity rate (i.e., either IgG or IgM > 10 AU) was 50%. IgM levels (AU/mL) (W = 33428.000, P ≤ 0.001) and IgG levels (AU/mL) (W = 39256.500, P ≤ 0.001), with the median IgM/ IgG levels (AU/mL), were highest in the RT-PCR-Positive group compared to RT-PCR-Negative clinical COVID-19. There was no significant difference between the two groups in terms of all other clinical outcomes (disease severity, septic shock, ICU admission, mechanical ventilation, and mortality).
CONCLUSIONS: The study showed that serology levels are high in RT-PCR positive group compared to clinical COVID-19. However, serology cannot be useful for the prediction of disease outcomes. The study also highlights the importance of doing serology at a particular time as antibody titers vary with the duration of the disease. In week intervals there was a significant correlation between clinical outcomes and serology on week 3.