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Elevated Serum IgM Levels Indicate Poor Outcome in Patients with Coronavirus Disease 2019 Pneumonia: A Retrospective Case-Control Study

17 Pages Posted: 31 Mar 2020

See all articles by Zhihua Wang

Zhihua Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Urology

Huijun Li

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Clinical Laboratory

Jingjing Li

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Clinical Laboratory

Chunguang Yang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Urology

Xiaolin Guo

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Urology

Zhiquan Hu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Urology

Zhiqiang Chen

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Urology

Shaogang Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Urology

Jihong Liu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Urology

Wengang Li

Xiamen University

More...

Abstract

Background: The coronavirus disease 2019 (COVID-19) pneumonia outbreak began in Wuhan and pandemics tend to occur. Although SARS-CoV-2-specific immunoglobulins have been detected in serum of COVID-19 patients, their dynamics and association with outcomes have not been characterized.

Methods: A total of 116 hospitalized patients with confirmed COVID-19 pneumonia and SARS-CoV-2-specific immunoglobulins tested in Tongji Hospital were retrospectively investigated. Clinical, laboratory, radiological characteristics and outcomes data were compared between mild-moderate group and died group. Further, a paired case-control study was conducted where each dead case was matched to three mild-moderate patients of similar age.

Findings: Among 116 subjects included, 101 mild-moderate patients survived and 15 cases died. SARS-CoV-2-specific IgM levels peaked in forth week after onset of COVID-19 pneumonia, while serum IgG levels increased over 8 weeks. Serum IgM levels were higher in dead patients than mild-moderate patients (p =0.024), but not IgG. Serum IgM levels were negatively correlated with clinical outcome, eosinophil count and albumin levels (r = -0.269, P=0.003; r = -0.188, P = 0.043; and r = -0.198, P=0.033, resp.). The area under the ROC curve (AUC) for IgM antibody was 0.681 (95% CI: 0.517-0.845, P = 0.024). In case-control study paired by age, serum IgM was higher in dead patients than mild-moderate patients (p =0.019), positively correlated with leucocyte count (r = 0.260, P = 0.045), while negatively correlated with clinical outcome and albumin levels (r = -0.337, P=0.008; r = -0.265, P = 0.041). AUC for IgM levels was 0.704 (95% CI: 0.534-0.873, P = 0.019).

Interpretation: These results indicate that dynamics of SARS-CoV-2 specific IgM and IgG antibodies was similar with that of SARS-CoV, while elevated serum IgM levels indicate poor outcome in patients with COVID-19 pneumonia.

Funding Statement: This work was supported by National Natural Science Foundation of China (No.81702989).

Declaration of Interests: The authors declare no conflict of interest.

Ethics Approval Statement: This study was reviewed and approved by the Medical Ethical Committee of Tongji Hospital of Huazhong University of Science and Technology (IRB ID: TJIRB20200343).

Keywords: 2019-nCoV; SARS-CoV-2; COVID-19; Coronavirus; Immunoglobulin

Suggested Citation

Wang, Zhihua and Li, Huijun and Li, Jingjing and Yang, Chunguang and Guo, Xiaolin and Hu, Zhiquan and Chen, Zhiqiang and Wang, Shaogang and Liu, Jihong and Li, Wengang, Elevated Serum IgM Levels Indicate Poor Outcome in Patients with Coronavirus Disease 2019 Pneumonia: A Retrospective Case-Control Study (3/16/2020). Available at SSRN: https://ssrn.com/abstract=3557987 or http://dx.doi.org/10.2139/ssrn.3557987

Zhihua Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Urology

China

Huijun Li

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Clinical Laboratory

1239 Siping Road
Shanghai, 200092
China

Jingjing Li

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Clinical Laboratory

China

Chunguang Yang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Urology ( email )

China

Xiaolin Guo

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Urology

China

Zhiquan Hu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Urology

China

Zhiqiang Chen

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Urology ( email )

China

Shaogang Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Urology ( email )

China

Jihong Liu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Urology ( email )

China

Wengang Li (Contact Author)

Xiamen University

Xiamen, Fujian 361005
China

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