Anti-nucleocapsid antibody levels and pulmonary comorbid conditions are linked to post-COVID-19 syndrome

  • JCI Insight. 2022 Jul 8;7(13):e156713. doi: 10.1172/jci.insight.156713.
Xiaolin Jia  1  2 ,  Shu Cao  1  3 ,  Alexandra S Lee  1  3 ,  Monali Manohar  1  3 ,  Sayantani B Sindher  1  3 ,  Neera Ahuja  1  2 ,  Maja Artandi  1  4 ,  Catherine A Blish  1  5  6  7 ,  Andra L Blomkalns  8 ,  Iris Chang  1  3 ,  William J Collins  1  2  3 ,  Manisha Desai  1  3  9 ,  Hena Naz Din  1  3 ,  Evan Do  1  3 ,  Andrea Fernandes  1  3 ,  Linda N Geng  1  4 ,  Yael Rosenberg-Hasson  1  3 ,  Megan Ruth Mahoney  1  4 ,  Abigail L Glascock  5 ,  Lienna Y Chan  5 ,  Sharon Y Fong  5 ,  CLIAHUB Consortium ,  Chan Zuckerberg Biohub ,  Maira Phelps  5 ,  Olivia Raeber  1  3 ,  Stanford COVID-19 Biobank Study Group ,  Natasha Purington  1  3  9 ,  Katharina Röltgen  10 ,  Angela J Rogers  1  11 ,  Theo Snow  1  3 ,  Taia T Wang  1  6  7 ,  Daniel Solis  10 ,  Laura Vaughan  1  4 ,  Michelle Verghese  10 ,  Holden Maecker  12 ,  Richard Wittman  1  4 ,  Rajan Puri  1  4 ,  Amy Kistler  5 ,  Samuel Yang  8 ,  Scott D Boyd  1  3  10 ,  Benjamin A Pinsky  6  10 ,  Sharon Chinthrajah  1  3 ,  Kari C Nadeau  1  3  11  12
Affiliations
  • 1. Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
  • 2. Division of Hospital Medicine.
  • 3. Sean N. Parker Center for Allergy and Asthma Research.
  • 4. Division of Primary Care and Population Health Stanford University, Stanford, California, USA.
  • 5. Chan Zuckerberg Biohub, San Francisco, California, USA.
  • 6. Division of Infectious Diseases, Stanford University, Stanford, California, USA.
  • 7. Department of Microbiology and Immunology, Stanford University, Stanford, California, USA.
  • 8. Department of Emergency Medicine, Stanford University, Stanford, California, USA.
  • 9. Quantitative Sciences Unit, Stanford University, Stanford, California, USA.
  • 10. Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
  • 11. Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, California, USA.
  • 12. Institute for Immunity, Transplantation, and Infectious Diseases, Stanford University, Stanford, California, USA.
PMID: 35801588 DOI: 10.1172/jci.insight.156713
Abstract

BACKGROUNDProlonged symptoms after SARS-CoV-2 Infection are well documented. However, which factors influence development of long-term symptoms, how symptoms vary across ethnic groups, and whether long-term symptoms correlate with biomarkers are points that remain elusive.METHODSAdult SARS-CoV-2 reverse transcription PCR-positive (RT-PCR-positive) patients were recruited at Stanford from March 2020 to February 2021. Study participants were seen for in-person visits at diagnosis and every 1-3 months for up to 1 year after diagnosis; they completed symptom surveys and underwent blood draws and nasal swab collections at each visit.RESULTSOur cohort (n = 617) ranged from asymptomatic to critical COVID-19 infections. In total, 40% of participants reported at least 1 symptom associated with COVID-19 six months after diagnosis. Median time from diagnosis to first resolution of all symptoms was 44 days; median time from diagnosis to sustained symptom resolution with no recurring symptoms for 1 month or longer was 214 days. Anti-nucleocapsid IgG level in the first week after positive RT-PCR test and history of lung disease were associated with time to sustained symptom resolution. COVID-19 disease severity, ethnicity, age, sex, and remdesivir use did not affect time to sustained symptom resolution.CONCLUSIONWe found that all disease severities had a similar risk of developing post-COVID-19 syndrome in an ethnically diverse population. Comorbid lung disease and lower levels of initial IgG response to SARS-CoV-2 nucleocapsid antigen were associated with longer symptom duration.TRIAL REGISTRATIONClinicalTrials.gov, NCT04373148.FUNDINGNIH UL1TR003142 CTSA grant, NIH U54CA260517 grant, NIEHS R21 ES03304901, Sean N Parker Center for Allergy and Asthma Research at Stanford University, Chan Zuckerberg Biohub, Chan Zuckerberg Initiative, Sunshine Foundation, Crown Foundation, and Parker Foundation.

Keywords
Immunoglobulins; Infectious disease.
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