Ján Jurenka, Anna Nagyová, Mohammad Dababseh, Peter Mihalov, Igor Stankovič, Vladimír Boža, Marián Kravec, Michal Palkovič, Martin Čaprnda, Peter Sabaka. Anti-SARS-CoV-2 Antibody Status at the Time of Hospital Admission and the Prognosis of Patients with COVID-19: A Prospective Observational Study. Infectious Disease Reports, 14(6):1004-1016. 2022.

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The association between COVID-19 severity and antibody response has not 
been clearly determined. We aimed to assess the effects of antibody 
response to SARS-CoV-2 S protein at the time of hospital admission on in-
hospital and longitudinal survival. Methods: A prospective observational 
study in naive hospitalised COVID-19 patients. The presence of anti-S SARS-
CoV-2 IgM and IgG was evaluated using a lateral flow assay at the time of 
admission. The patients were followed up for 8–30 months to assess 
survival. We recruited 554 patients (330 men and 224 women). Overall, 63.0% 
of the patients had positive IgG or IgM anti-S SARS-CoV-2 antibodies at the 
time of hospital admission. In the univariate analysis, the patients with 
negative anti-S SARS-CoV-2 IgM and IgG antibodies were referred to the 
hospital sooner, had lower CRP and D-dimer concentrations, and were 
hospitalised longer. They were also more likely to be admitted to an 
intensive care unit and more often received baricitinib treatment. During 
their hospital stay, 8.5% of the antibody-positive and 22.3% of the 
antibody-negative patients died (p = 0.0001). The median duration of the 
follow-up was 21 months. During the follow-up after hospital discharge, 
3.6% of antibody-positive and 9.1% of antibody-negative patients died (p = 
0.027). In the multivariate analysis, the negative anti-S SARS-CoV-2 
antibodies were associated with a higher risk of in-hospital death (OR 
3.800; 95% CI 1.844–7.829; p = 0.0001) and with a higher risk of death 
during follow-up (OR 2.863; 95% CI 1.110–7.386; p = 0.030). These 
associations were independent of age, the time from symptom onset to 
hospital admission, CRP, D-Dimer, the number of comorbidities, disease 
severity at the time of hospital admission, and baricitinib therapy. Our 
study concludes that negative anti-S SARS-CoV-2 IgM and IgG at the time of 
admission are associated with higher in-hospital mortality and cause a 
higher risk of all-cause death during follow-up after discharge.