Low anti‐SARS‐CoV‐2 S antibody levels predict increased mortality and dissemination of viral components in the blood of critical COVID‐19 patients
María Martin‐Vicente, Raquel Almansa, Isidoro Martínez, Ana P. Tedim, Elena Bustamante, Luís Tamayo, César Aldecoa, José Manuel Gómez, Gloria Renedo, José Ángel Berezo, Jamil Cedeño, Nuria Mamolar, Pablo García Olivares, Rubén Herrán‐Monge, Ramón Cicuéndez, Pedro Enríquez, Alicia Ortega, Noelia Jorge, Cristina Doncel, Amanda de la Fuente, Juan Bustamante‐Munguira, María José Muñoz‐Gómez, Milagros González‐Rivera, Carolina Puertas, Vicente Más, Mónica Vázquez, Felipe Pérez‐García, Jesús Rico-Feijoó, Silvia Martín, Ana Motos, Laia Fernández‐Barat, José María Eirós Bouza, Marta Domínguez‐Gil, Ricard Ferrer, Ferrán Barbé, Wysali Trapiello, David J. Kelvin, Jesús F. Bermejo-Martín, Salvador Resino, Antoní Torres
Abstract
BACKGROUND: Anti-SARS-CoV-2 S antibodies prevent viral replication. Critically ill COVID-19 patients show viral material in plasma, associated with a dysregulated host response. If these antibodies influence survival and viral dissemination in ICU-COVID patients is unknown. PATIENTS/METHODS: We studied the impact of anti-SARS-CoV-2 S antibodies levels on survival, viral RNA-load in plasma, and N-antigenaemia in 92 COVID-19 patients over ICU admission. RESULTS: Frequency of N-antigenaemia was >2.5-fold higher in absence of antibodies. Antibodies correlated inversely with viral RNA-load in plasma, representing a protective factor against mortality (adjusted HR [CI 95%], p): (S IgM [AUC ≥ 60]: 0.44 [0.22; 0.88], 0.020); (S IgG [AUC ≥ 237]: 0.31 [0.16; 0.61], <0.001). Viral RNA-load in plasma and N-antigenaemia predicted increased mortality: (N1-viral load [≥2.156 copies/ml]: 2.25 [1.16; 4.36], 0.016); (N-antigenaemia: 2.45 [1.27; 4.69], 0.007). CONCLUSIONS: Low anti-SARS-CoV-2 S antibody levels predict mortality in critical COVID-19. Our findings support that these antibodies contribute to prevent systemic dissemination of SARS-CoV-2.