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Impaired systemic nucleocapsid antigen clearance in severe COVID-19
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  • Christian Bauer,
  • Elisabeth Mack,
  • Véronique Hefter,
  • Alexandra Fischer,
  • Kirsten Volland,
  • Chrysanthi Skevaki,
  • Andreas Neubauer,
  • Thomas Gress,
  • Stephan Becker,
  • Christian Keller
Christian Bauer
Philipps-Universitat Marburg
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Elisabeth Mack
Philipps-Universitat Marburg
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Véronique Hefter
Philipps-Universitat Marburg
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Alexandra Fischer
Philipps-Universitat Marburg
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Kirsten Volland
Philipps-Universitat Marburg
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Chrysanthi Skevaki
Philipps-Universitat Marburg
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Andreas Neubauer
Philipps-Universitat Marburg
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Thomas Gress
Philipps-Universitat Marburg
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Stephan Becker
Philipps-Universitat Marburg
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Christian Keller
Philipps-Universitat Marburg

Corresponding Author:christian.keller@staff.uni-marburg.de

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Abstract

Objectives: Circulating nucleocapsid (NCP) antigen of SARS-CoV-2 is increased in severely ill COVID-19 patients. However, clinical deterioration of COVID-19 often happens about one week after benign initial presentation. The role of NCP antigenemia as a biomarker in those cases remains unclear. We investigated NCP clearance kinetics in hospitalized patients as a risk assessment tool for predicting necessity of intensive care treatment of COVID-19 patients. Methods: Serum NCP was quantified using a commercial NCP-specific ELISA in hospitalized COVID-19 patients (n=63) during their hospital stay. Results were correlated to COVID-19 disease severity, inflammation parameters, antibody response and results of SARS-CoV-2 PCR from nasopharyngeal swabs.   Results: We demonstrate that NCP antigen levels in serum remained elevated in 45.6% of patients requiring treatment on intensive care units (ICU) after >8 days post positive SARS-CoV-2 PCR, compared to complete clearance in all non-ICU patients. This was in contrast to mucosal clearance of virus as measured by PCR. Antigen clearance was associated with higher IgG against S1 but not NCP.   Conclusions: Detection of NCP antigenemia after 8 days post COVID-19 diagnosis identifies patients who will require intensive care. Lack of NCP clearance after one week can thus help to assess the risk to develop severe COVID-19.
23 Mar 2023Submitted to Journal of Medical Virology
23 Mar 2023Submission Checks Completed
23 Mar 2023Assigned to Editor
23 Mar 2023Review(s) Completed, Editorial Evaluation Pending
28 Mar 2023Reviewer(s) Assigned
28 Apr 2023Editorial Decision: Revise Major
22 Jun 20231st Revision Received
22 Jun 2023Submission Checks Completed
22 Jun 2023Assigned to Editor
22 Jun 2023Review(s) Completed, Editorial Evaluation Pending
23 Jun 2023Reviewer(s) Assigned
17 Jul 2023Editorial Decision: Revise Major
19 Jul 20232nd Revision Received
20 Jul 2023Submission Checks Completed
20 Jul 2023Assigned to Editor
20 Jul 2023Review(s) Completed, Editorial Evaluation Pending
20 Jul 2023Reviewer(s) Assigned
03 Aug 2023Editorial Decision: Accept