Monitoring Specific IgM and IgG Production Among Severe COVID-19 Patients Using Qualitative and Quantitative Immunodiagnostic Assays: A Retrospective Cohort Study

The purpose of this study is to monitor specific anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) IgG and IgM antibody production in patients with severe forms of coronavirus disease 2019 (COVID-19) using various commercially available quantitative and qualitative tests. The sera of 23 confirmed COVID-19 patients were processed for anti-SARS-CoV-2 IgG and IgM detection. Three different immunoassays, viz. Abbott Architect (R) SARS-CoV-2 IgG assay, and two quantitative tests, ANSH (R) SARSCoV-2 and AESKULISA (R) SARS-CoV-2 Nucleocapsid Protein (NP), were performed and the results pooled, from diagnosis to serum collection. Seroconversion rates were computed for all 3 assays, and possible correlations were tested using the Pearson correlation coefficient and Cohen's kappa coefficient. Overall, 70 combinations of qualitative and quantitative IgG and IgM results were pooled and analyzed. In the early phase (0-4 days after diagnosis), in all tests, IgG seroconversion rates were 43%-61%, and increased in all tests gradually to 100% after 15 days. The Pearson correlation coefficient showed a strong positive relationship between the qualitative IgG test results and both quantitative IgG tests. IgM detection was inconsistent, with maximal concentrations and seroconversion rates between 10-15 days after diagnosis and slight-to-fair agreement between the two quantitative immunoassays. There was no significant association between mortality with IgG or IgM seroconversion or concentrations. Patients with severe COVID-19 develop an early, robust anti-SARSCoV-2 specific humoral immune response involving IgG immunoglobulins. Further comparative studies are warranted to analyze the value of serological testing in predicting the severity of COVID-19 and detecting prior exposure.