Changes in serum virus-specific IgM/IgG antibody in asymptomatic and discharged patients with reoccurring positive COVID-19 nucleic acid test (RPNAT)

Ann Med. 2020 Aug 18;1-14. doi: 10.1080/07853890.2020.1811887. Online ahead of print.

Abstract

Background Studies have demonstrated the diagnostic efficiency of antibody testing in COVID-19 infection. There is limited data on the IgM/IgG changes in asymptomatic and discharged patients with reoccurring positive nucleic acid test (RPNAT). This study aims to investigate these IgM/IgG changes.Methods There were 111 patients with positive nucleic acid test (NAT) and 40 suspected patients enrolled in the study. The serum SARS-CoV-2 specific IgM/IgG antibody levels were retrospectively analyzed with the disease progress in asymptomatic and RPNAT patients.Results The best overall performance was found by combining the IgM, IgG, and CT; 95.1% sensitivity and 75% specificity. This was tested in 111 RT-PCR positive cases. The median IgM and IgG levels were lower in the asymptomatic group compared to the symptomatic group (P < 0.01). Among 15 RPNAT cases, the IgM levels of the RPNAT group at the time of discharge (IgM2.79, IQR: 0.95-5.37) and retest (IgM 2.35, IQR: 0.88-8.65) were significantly higher than those of the non-reoccurring positive nucleic acid test group (Non-RPNAT) (IgM on discharge: 0.59, IQR: 0.33-1.22, IgG on retest: 0.92, IQR: 0.51-1.58).Conclusion Serum SARS-CoV-2 specific IgM/IgG antibody levels remained at a low level during hospitalization for asymptomatic patients. Elevated IgM levels may have implications in the identification of RPNAT patients before discharge.

Keywords: COVID-19; IgM/IgG antibody; asymptomatic patient; discharged patient with reoccurring positive nucleic acid test (RPNAT).