Corona Virus Disease-19 serology, inflammatory markers, hospitalizations, case finding, and aging.

Most deaths from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection occur in older subjects. We assessed the utility of serum inflammatory markers interleukin-6 (IL-6), C reactive protein (CRP), and ferritin (Roche, Indianapolis, IN), and SARS-CoV-2 immunoglobulin G (IgG), immuno...

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Main Authors: Ernst J Schaefer, Latha Dulipsingh, Florence Comite, Jessica Jimison, Martin M Grajower, Nathan E Lebowitz, Maxine Lang, Andrew S Geller, Margaret R Diffenderfer, Lihong He, Gary Breton, Michael L Dansinger, Ben Saida, Chong Yuan
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2021-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0252818
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spelling doaj-063b80c667fa44b8aaa8fc14333c20412021-06-26T04:31:31ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01166e025281810.1371/journal.pone.0252818Corona Virus Disease-19 serology, inflammatory markers, hospitalizations, case finding, and aging.Ernst J SchaeferLatha DulipsinghFlorence ComiteJessica JimisonMartin M GrajowerNathan E LebowitzMaxine LangAndrew S GellerMargaret R DiffenderferLihong HeGary BretonMichael L DansingerBen SaidaChong YuanMost deaths from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection occur in older subjects. We assessed the utility of serum inflammatory markers interleukin-6 (IL-6), C reactive protein (CRP), and ferritin (Roche, Indianapolis, IN), and SARS-CoV-2 immunoglobulin G (IgG), immunoglobulin M (IgM), and neutralizing antibodies (Diazyme, Poway, CA). In controls, non-hospitalized subjects, and hospitalized subjects assessed for SARS-CoV-2 RNA (n = 278), median IgG levels in arbitrary units (AU)/mL were 0.05 in negative subjects, 14.83 in positive outpatients, and 30.61 in positive hospitalized patients (P<0.0001). Neutralizing antibody levels correlated significantly with IgG (r = 0.875; P<0.0001). Having combined values of IL-6 ≥10 pg/mL and CRP ≥10 mg/L occurred in 97.7% of inpatients versus 1.8% of outpatients (odds ratio 3,861, C statistic 0.976, P = 1.00 x 10-12). Antibody or ferritin levels did not add significantly to predicting hospitalization. Antibody testing in family members and contacts of SARS-CoV-2 RNA positive cases (n = 759) was invaluable for case finding. Persistent IgM levels were associated with chronic COVID-19 symptoms. In 81,624 screened subjects, IgG levels were positive (≥1.0 AU/mL) in 5.21%, while IgM levels were positive in 2.96% of subjects. In positive subjects median IgG levels in AU/mL were 3.14 if <30 years of age, 4.38 if 30-44 years of age, 7.89 if 45-54 years of age, 9.52 if 55-64 years of age, and 10.64 if ≥65 years of age (P = 2.96 x 10-38). Our data indicate that: 1) combined IL-6 ≥10 pg/mL and CRP ≥10 mg/L identify SARS-CoV-2 positive subjects requiring hospitalization; 2) IgG levels were significantly correlated with neutralizing antibody levels with a wide range of responses; 3) IgG levels have significant utility for case finding in exposed subjects; 4) persistently elevated IgM levels are associated with chronic symptoms; and 5) IgG levels are significantly higher in positive older subjects than their younger counterparts.https://doi.org/10.1371/journal.pone.0252818
collection DOAJ
language English
format Article
sources DOAJ
author Ernst J Schaefer
Latha Dulipsingh
Florence Comite
Jessica Jimison
Martin M Grajower
Nathan E Lebowitz
Maxine Lang
Andrew S Geller
Margaret R Diffenderfer
Lihong He
Gary Breton
Michael L Dansinger
Ben Saida
Chong Yuan
spellingShingle Ernst J Schaefer
Latha Dulipsingh
Florence Comite
Jessica Jimison
Martin M Grajower
Nathan E Lebowitz
Maxine Lang
Andrew S Geller
Margaret R Diffenderfer
Lihong He
Gary Breton
Michael L Dansinger
Ben Saida
Chong Yuan
Corona Virus Disease-19 serology, inflammatory markers, hospitalizations, case finding, and aging.
PLoS ONE
author_facet Ernst J Schaefer
Latha Dulipsingh
Florence Comite
Jessica Jimison
Martin M Grajower
Nathan E Lebowitz
Maxine Lang
Andrew S Geller
Margaret R Diffenderfer
Lihong He
Gary Breton
Michael L Dansinger
Ben Saida
Chong Yuan
author_sort Ernst J Schaefer
title Corona Virus Disease-19 serology, inflammatory markers, hospitalizations, case finding, and aging.
title_short Corona Virus Disease-19 serology, inflammatory markers, hospitalizations, case finding, and aging.
title_full Corona Virus Disease-19 serology, inflammatory markers, hospitalizations, case finding, and aging.
title_fullStr Corona Virus Disease-19 serology, inflammatory markers, hospitalizations, case finding, and aging.
title_full_unstemmed Corona Virus Disease-19 serology, inflammatory markers, hospitalizations, case finding, and aging.
title_sort corona virus disease-19 serology, inflammatory markers, hospitalizations, case finding, and aging.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2021-01-01
description Most deaths from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection occur in older subjects. We assessed the utility of serum inflammatory markers interleukin-6 (IL-6), C reactive protein (CRP), and ferritin (Roche, Indianapolis, IN), and SARS-CoV-2 immunoglobulin G (IgG), immunoglobulin M (IgM), and neutralizing antibodies (Diazyme, Poway, CA). In controls, non-hospitalized subjects, and hospitalized subjects assessed for SARS-CoV-2 RNA (n = 278), median IgG levels in arbitrary units (AU)/mL were 0.05 in negative subjects, 14.83 in positive outpatients, and 30.61 in positive hospitalized patients (P<0.0001). Neutralizing antibody levels correlated significantly with IgG (r = 0.875; P<0.0001). Having combined values of IL-6 ≥10 pg/mL and CRP ≥10 mg/L occurred in 97.7% of inpatients versus 1.8% of outpatients (odds ratio 3,861, C statistic 0.976, P = 1.00 x 10-12). Antibody or ferritin levels did not add significantly to predicting hospitalization. Antibody testing in family members and contacts of SARS-CoV-2 RNA positive cases (n = 759) was invaluable for case finding. Persistent IgM levels were associated with chronic COVID-19 symptoms. In 81,624 screened subjects, IgG levels were positive (≥1.0 AU/mL) in 5.21%, while IgM levels were positive in 2.96% of subjects. In positive subjects median IgG levels in AU/mL were 3.14 if <30 years of age, 4.38 if 30-44 years of age, 7.89 if 45-54 years of age, 9.52 if 55-64 years of age, and 10.64 if ≥65 years of age (P = 2.96 x 10-38). Our data indicate that: 1) combined IL-6 ≥10 pg/mL and CRP ≥10 mg/L identify SARS-CoV-2 positive subjects requiring hospitalization; 2) IgG levels were significantly correlated with neutralizing antibody levels with a wide range of responses; 3) IgG levels have significant utility for case finding in exposed subjects; 4) persistently elevated IgM levels are associated with chronic symptoms; and 5) IgG levels are significantly higher in positive older subjects than their younger counterparts.
url https://doi.org/10.1371/journal.pone.0252818
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