JCI Insight (Jul 2022)

Anti-nucleocapsid antibody levels and pulmonary comorbid conditions are linked to post–COVID-19 syndrome

  • Xiaolin Jia,
  • Shu Cao,
  • Alexandra S. Lee,
  • Monali Manohar,
  • Sayantani B. Sindher,
  • Neera Ahuja,
  • Maja Artandi,
  • Catherine A. Blish,
  • Andra L. Blomkalns,
  • Iris Chang,
  • William J. Collins,
  • Manisha Desai,
  • Hena Naz Din,
  • Evan Do,
  • Andrea Fernandes,
  • Linda N. Geng,
  • Yael Rosenberg-Hasson,
  • Megan Ruth Mahoney,
  • Abigail L. Glascock,
  • Lienna Y. Chan,
  • Sharon Y. Fong,
  • CLIAHUB Consortium,
  • Chan Zuckerberg Biohub,
  • Maira Phelps,
  • Olivia Raeber,
  • Stanford COVID-19 Biobank Study Group,
  • Natasha Purington,
  • Katharina Röltgen,
  • Angela J. Rogers,
  • Theo Snow,
  • Taia T. Wang,
  • Daniel Solis,
  • Laura Vaughan,
  • Michelle Verghese,
  • Holden Maecker,
  • Richard Wittman,
  • Rajan Puri,
  • Amy Kistler,
  • Samuel Yang,
  • Scott D. Boyd,
  • Benjamin A. Pinsky,
  • Sharon Chinthrajah,
  • Kari C. Nadeau

Journal volume & issue
Vol. 7, no. 13

Abstract

Read online

BACKGROUND Prolonged symptoms after SARS-CoV-2 infection are well documented. However, which factors influence development of long-term symptoms, how symptoms vary across ethnic groups, and whether long-term symptoms correlate with biomarkers are points that remain elusive.METHODS Adult SARS-CoV-2 reverse transcription PCR–positive (RT-PCR–positive) patients were recruited at Stanford from March 2020 to February 2021. Study participants were seen for in-person visits at diagnosis and every 1–3 months for up to 1 year after diagnosis; they completed symptom surveys and underwent blood draws and nasal swab collections at each visit.RESULTS Our cohort (n = 617) ranged from asymptomatic to critical COVID-19 infections. In total, 40% of participants reported at least 1 symptom associated with COVID-19 six months after diagnosis. Median time from diagnosis to first resolution of all symptoms was 44 days; median time from diagnosis to sustained symptom resolution with no recurring symptoms for 1 month or longer was 214 days. Anti-nucleocapsid IgG level in the first week after positive RT-PCR test and history of lung disease were associated with time to sustained symptom resolution. COVID-19 disease severity, ethnicity, age, sex, and remdesivir use did not affect time to sustained symptom resolution.CONCLUSION We found that all disease severities had a similar risk of developing post–COVID-19 syndrome in an ethnically diverse population. Comorbid lung disease and lower levels of initial IgG response to SARS-CoV-2 nucleocapsid antigen were associated with longer symptom duration.TRIAL REGISTRATION ClinicalTrials.gov, NCT04373148.FUNDING NIH UL1TR003142 CTSA grant, NIH U54CA260517 grant, NIEHS R21 ES03304901, Sean N Parker Center for Allergy and Asthma Research at Stanford University, Chan Zuckerberg Biohub, Chan Zuckerberg Initiative, Sunshine Foundation, Crown Foundation, and Parker Foundation.

Keywords