Immunological Characteristics of Unvaccinated Patients with COVID-19 in the Early Pandemic Period
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Background: Immune responses to infectious disease differ according to disease severity. In this study, we investigated the overall laboratory profiles, including antibody titers and cytokine levels in unvaccinated patients with Coronavirus Disease 2019 (COVID-19), according to disease severity at the initial stage during the early pandemic period. Methods: In total, 195 unvaccinated patients with COVID-19, who were hospitalized from February to August 2020 were enrolled in this study. The patients were divided into five severity categories, and their antibody titers and cytokine levels were evaluated by collecting serial blood samples up to the first three months after infection. Results: Older male patients with comorbidities had a higher probability of rapid disease progression. Patients who required intensive care showed significantly lower initial hemoglobin, platelet counts, total protein, and albumin levels, with significantly higher neutrophil-to-lymphocyte ratios, blood urea nitrogen, creatinine, and coagulation, cardiac, and inflammatory markers compared to those in patients who did not require intensive care. At three weeks after infection, the titers of both the anti-receptor binding domain of spike protein and neutralizing antibodies were significantly higher in patients with high disease severity than in patients with low disease severity; a similar trend was observed for IL-6 and TNF-α levels for at least three months from infection onset. Conclusions: Antibody and pro-inflammatory cytokine levels showed a significant difference according to disease severity in the early stage of infection. Therefore, development of drugs targeting these antibodies and cytokines may help alleviate the severity of COVID-19.
Abstract
Background: Immune responses to infectious disease differ according to disease severity. In this study, we investigated the overall laboratory profiles, including antibody titers and cytokine levels in unvaccinated patients with Coronavirus Disease 2019 (COVID-19), according to disease severity at the initial stage during the early pandemic period. Methods: In total, 195 unvaccinated patients with COVID-19, who were hospitalized from February to August 2020 were enrolled in this study. The patients were divided into five severity categories, and their antibody titers and cytokine levels were evaluated by collecting serial blood samples up to the first three months after infection. Results: Older male patients with comorbidities had a higher probability of rapid disease progression. Patients who required intensive care showed significantly lower initial hemoglobin, platelet counts, total protein, and albumin levels, with significantly higher neutrophil-to-lymphocyte ratios, blood urea nitrogen, creatinine, and coagulation, cardiac, and inflammatory markers compared to those in patients who did not require intensive care. At three weeks after infection, the titers of both the anti-receptor binding domain of spike protein and neutralizing antibodies were significantly higher in patients with high disease severity than in patients with low disease severity; a similar trend was observed for IL-6 and TNF-α levels for at least three months from infection onset. Conclusions: Antibody and pro-inflammatory cytokine levels showed a significant difference according to disease severity in the early stage of infection. Therefore, development of drugs targeting these antibodies and cytokines may help alleviate the severity of COVID-19.
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