Early Humoral Response Correlates with Disease Severity and Outcomes in COVID-19 Patients

Viruses. 2020 Dec 4;12(12):1390. doi: 10.3390/v12121390.


The Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, continues to spread globally with significantly high morbidity and mortality rates. Antigen-specific responses are of unquestionable value for clinical management of COVID-19 patients. Here, we investigated the kinetics of IgM, IgG against the spike (S) and nucleoproteins (N) proteins and their neutralizing capabilities in hospitalized COVID-19 patients with different disease presentations (i.e., mild, moderate or severe), need for intensive care units (ICU) admission or outcomes (i.e., survival vs death). We show that SARS-CoV-2 specific IgG, IgM and neutralizing antibodies (nAbs) were readily detectable in almost all COVID-19 patients with various clinical presentations. Interestingly, significantly higher levels of nAbs as well as anti-S1 and -N IgG and IgM antibodies were found in patients with more severe symptoms, patients requiring admission to ICU or those with fatal outcomes. More importantly, early after symptoms onset, we found that the levels of anti-N antibodies correlated strongly with disease severity. Collectively, these findings provide new insights into the kinetics of antibody responses in COVID-19 patients with different disease severity.

Keywords: COVID19; SARS-CoV-2; anti-N antibodies; neutralizing antibodies.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Neutralizing / blood
  • Antibodies, Viral / blood*
  • COVID-19 / diagnosis
  • COVID-19 / immunology*
  • Hospitalization
  • Humans
  • Immunity, Humoral*
  • Immunoglobulin G / blood*
  • Immunoglobulin M / blood
  • Kinetics
  • Longitudinal Studies
  • Neutralization Tests
  • Nucleocapsid Proteins / immunology
  • Severity of Illness Index
  • Spike Glycoprotein, Coronavirus / immunology


  • Antibodies, Neutralizing
  • Antibodies, Viral
  • Immunoglobulin G
  • Immunoglobulin M
  • Nucleocapsid Proteins
  • Spike Glycoprotein, Coronavirus
  • spike protein, SARS-CoV-2