Predicting COVID-19 Severity with a Specific Nucleocapsid Antibody plus Disease Risk Factor Score.

Abstract

Effective methods for predicting COVID-19 disease trajectories are urgently needed. Here, ELISA and coronavirus antigen microarray (COVAM) analysis mapped antibody epitopes in the plasma of COVID-19 patients (n = 86) experiencing a wide-range of disease states. The experiments identified antibodies to a 21-residue epitope from nucleocapsid (termed Ep9) associated with severe disease, including admission to the ICU, requirement for ventilators, or death. Importantly, anti-Ep9 antibodies can be detected within six days post-symptom onset and sometimes within one day. Furthermore, anti-Ep9 antibodies correlate with various comorbidities and hallmarks of immune hyperactivity. We introduce a simple-to-calculate, disease risk factor score to quantitate each patients comorbidities and age. For patients with anti-Ep9 antibodies, scores above 3.0 predict more severe disease outcomes with a 13.42 Likelihood Ratio (96.7% specificity). The results lay the groundwork for a new type of COVID-19 prognostic to allow early identification and triage of high-risk patients. Such information could guide more effective therapeutic intervention.

• Authors: Sanjana Sen, Emily C Sanders, Kristin N Gabriel, Brian M Miller, Hariny M Isoda, Gabriela S Salcedo, Jason E Garrido, Rebekah P Dyer, Rie Nakajima, Aarti Jain, Ana-Maria Caldaruse, Alicia M Santos, Keertna Bhuvan, Delia F Tifrea, Joni L Ricks-Oddie, Philip L Felgner, Robert A Edwards, Sudipta Majumdar, Gregory A Weiss
• Journal: bioRxiv : the preprint server for biology (bioRxiv) (Mar 08 2021) United States
• PMID: 33083803 (Publication Type: Preprint)