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. 2021 Dec;53(1):34-42.
doi: 10.1080/07853890.2020.1811887. Epub 2020 Oct 1.

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

Junli Liu  1 , Rui Lian  2 , Guochao Zhang  3 , Baojun Hou  4 , Chuming Wang  1 , Jian Dong  5 , Liu Yang  1 , Jianglan Wang  1 , Shangming Dai  1 , Libo Chen  6 , Guoqiang Zhang  2 , Xin Lu  7 , Ting Ye  8
Affiliations

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

Junli Liu et al. Ann Med. 2021 Dec.

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 analysed 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 < .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 hospitalisation for asymptomatic patients. Elevated IgM levels may have implications in the identification of RPNAT patients before discharge. Key messages This study determined the IgM/IgG changes in asymptomatic and RPNAT patients. The rate of serum SARS-CoV-2 specific IgM/IgG antibody levels increase in the asymptomatic group was lower than in the symptomatic group during hospitalisation. The IgM level did not decrease significantly at discharge in the RPNAT patients, and was higher than that of the Non-RPNAT group on discharge. These results highlight the importance of timely monitoring of IgM levels to identify RPNAT patients before discharge.

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

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Patients flow and enrolment. *Asymptomatic case: a nucleic acid test positive case with normal body temperature , no discomfort and without pneumonia imaging from admission to discharge. #Discharged patient who was retested positive: After the patient was discharged from the hospital, nucleic acid retest turned positive.
Figure 2.
Figure 2.
ROC curves of different testing items.
Figure 3.
Figure 3.
Dynamic changes of IgM/IgG levels in asymptomatic and symptomatic group. *Time point of blood collection for asymptomatic patients: from the day of close contact with the confirmed patient to blood samples collection. #Time point of blood collection for symptomatic patients: time from symptom onset to blood samples collection
See this image and copyright information in PMC

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