The impact of early anti-SARS-CoV-2 antibody production on the length of hospitalization stay among COVID-19 patients
Authors: de Almeida Dalziza Victalina , Cezar Priscila Alves , Fernandes Thais Freitas Barreto , Schwarz Marcos Gustavo Araujo , Mendonça-Lima Leila , Giacoia-Gripp Carmem Beatriz Wagner , Côrtes Fernanda Heloise , Lindenmeyer Guimarães Monick , Pilotto Jose Henrique , De Sá Nathalia Beatriz Ramos , Cazote Andressa da Silva , Gomes Larissa Rodrigues , Quintana Marcel de Souza Borges , Ribeiro-Alves Marcelo , Coelho Lara Esteves , Geraldo Kim Mattos , Ribeiro Maria Pia Diniz , Cardoso Sandra Wagner , Grinsztejn Beatriz , Veloso Valdiléa G , Morgado Mariza Gonçalves 
Published: October 2023

ABSTRACT

COVID-19 has challenged the scientific community in the search for biological markers and information that can contribute to the early management of the severe disease. Given the global scale of COVID-19, including reports of reinfection even in the presence of effective vaccines; consequently, the eradication of SARS-CoV-2 is far from happening. This study aimed to characterize the neutralizing antibody (Nab) geometric mean titers (GMTs) in hospitalized patients with COVID-19 and to evaluate the association with length of stay, comorbidities, and patient outcome. Among the 103 participants, 84 (81.5%) had some previous conditions associated with worsening health and 34 (33%) died. We found that neutralization potency varied greatly across individuals and was significantly higher in patients discharged before 14 days than in patients who stayed longer in the hospital. During the study period, 15 people living with HIV (PLWH) were hospitalized, and no significant difference in clinical characteristics or anti-SARS-CoV-2 Nabs was observed. However, PLWH with severe COVID-19 were younger [42, interquartile range (IQR) = 17.5] than other hospitalized COVID-19 patients (59, IQR = 22,
P
< 0.01). A high anti-HIV-1 antibody GMT of 583.9 (95% confidence interval: 344–990) was detected, demonstrating maintenance of anti-HIV-1 Nab production among PLWH coinfected with SARS-CoV-2. Therefore, these results indicate that neutralizing antibodies are not the only immunological response capable of controlling disease progression, but a high neutralizing response was associated with a shorter length of stay, suggesting the benefit of early-stage immunotherapy treatment of COVID-19. Nevertheless, these data highlight the importance of more Nab screening studies to predict faster recovery.

IMPORTANCE
The study provides valuable insights into the sociodemographic characteristics, clinical outcomes, and humoral immune response of those affected by the virus that has devastated every field of human life since 2019; the COVID-19 patients. Firstly, the association among clinical manifestations, comorbidities, and the production of neutralizing antibodies (Nabs) against SARS-CoV-2 is explored. Secondly, varying levels of Nabs among patients are revealed, and a significant correlation between the presence of Nabs and a shorter duration of hospitalization is identified, which highlights the potential role of Nabs in predicting clinical outcomes. Lastly, a follow-up conducted 7 months later demonstrates the progression and persistence of Nabs production in recovered unvaccinated individuals. The study contributes essential knowledge regarding the characteristics of the study population, the early humoral immune response, and the dynamics of Nabs production over time. These findings have significant implications for understanding the immune response to COVID-19 and informing clinical management approaches.