Relationship between Disease Severity, Immune Response, and Viral Clearance in Unvaccinated Patients with COVID-19: A Cross-sectional Study
Introduction: The clinical manifestations of Coronavirus Disease-2019 (COVID-19) range from asymptomatic cases to severe respiratory failure. It is unclear whether disease severity is determined by an excess viral load or a dysregulated immune response. It is also unclear whether the severe immu...
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| Format: | Article |
| Language: | English |
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JCDR Research and Publications Private Limited
2023-12-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://www.jcdr.net/articles/PDF/18788/63744_CE[Ra1]_F(SL)_QC&Ref(SD_SL)_PF1(VD_OM)_redo(VD_OM)_PFA(OM)_PN(OM).pdf |
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| author | Tushar Ramesh Sahasrabudhe Harshmeet Singh Gujral Nirmala Ananthi Muthukaruppan Mahavir Satishchand Bagrecha Madhu Sudan Barthwal Shahzad Mirza |
| author_facet | Tushar Ramesh Sahasrabudhe Harshmeet Singh Gujral Nirmala Ananthi Muthukaruppan Mahavir Satishchand Bagrecha Madhu Sudan Barthwal Shahzad Mirza |
| author_sort | Tushar Ramesh Sahasrabudhe |
| collection | DOAJ |
| description | Introduction: The clinical manifestations of Coronavirus
Disease-2019 (COVID-19) range from asymptomatic cases to
severe respiratory failure. It is unclear whether disease severity
is determined by an excess viral load or a dysregulated immune
response. It is also unclear whether the severe immune response
is successful in rapid viral clearance.
Aim: To understand the relationship between immune response,
viral clearance, and the severity of illness in unvaccinated
patients suffering from COVID-19.
Materials and Methods: This was a cross-sectional observational
study of 65 unvaccinated patients suffering from Reverse
Transcriptase-Polymerase Chain Reaction (RT-PCR) confirmed
COVID-19, conducted at a dedicated COVID-19 centre, Dr. D.Y.
Patil Hospital, Pimpri, Pune, Maharashtra, India. from September
2020 to April 2021. The subjects were enrolled between day
10 and day 14 of the onset of symptoms and from two distinct
clinical groups. Group A consisted of 34 mild cases, and Group B
consisted of 31 severe cases, classified according to the national
guidelines issued by the Indian Council of Medical Research
(ICMR). The clinical progress of the illness and laboratory test
records were carefully reviewed. A repeat throat swab for Severe
Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) RTPCR, blood levels of COVID-19 specific antibodies Immunoglobin
G (IgG) and IgM, C-reactive protein (CRP), and D-dimer levels
were measured on day 14 of the illness. The data were analysed
using MedCalc and Epi Info software. Chi-square and Fisher’sExact tests were used to assess variables such as viral detection,
antibody response, and inflammatory markers.
Results: In Group A, 2/34 (5.88%) patients tested RT-PCR
negative {Cycle threshold (Ct) value cut-off above 35} compared
to 5/31 (16.13%) in Group B (p=0.0829). In Groups A and B,
respectively, the mean antibody titers were 35390.47 and
36426.11 (p=0.7469), the mean CRP values were 4.91 (p<0.001)
and 31.01 mg/dL, and the mean D-dimer levels were 895 and
2896 ng/mL (p<0.001).
Conclusion: Both mild and severe COVID-19 cases had a
significant antibody response which, however, did not help in
viral clearance. Most patients remained RT-PCR positive on day
14 regardless of the disease severity. |
| first_indexed | 2024-03-08T23:49:28Z |
| format | Article |
| id | doaj.art-1f9bb8e6c59c435ca5438f27b5c10cbb |
| institution | Directory Open Access Journal |
| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-03-08T23:49:28Z |
| publishDate | 2023-12-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-1f9bb8e6c59c435ca5438f27b5c10cbb2023-12-13T11:24:59ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2023-12-011712010510.7860/JCDR/2023/63744.18788Relationship between Disease Severity, Immune Response, and Viral Clearance in Unvaccinated Patients with COVID-19: A Cross-sectional StudyTushar Ramesh Sahasrabudhe0Harshmeet Singh Gujral1 Nirmala Ananthi Muthukaruppan2Mahavir Satishchand Bagrecha3Madhu Sudan Barthwal4Shahzad Mirza5Professor, Department of Respiratory Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India.Junior Resident, Department of Respiratory Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India.Senior Specialist, Department of Pulmonary Medicine, Aster RV Hospital, Bengaluru, Karnataka, India.Associate Professor, Department of Respiratory Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India.Professor, Department of Respiratory Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India.Associate Professor, Department of Microbiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India.Introduction: The clinical manifestations of Coronavirus Disease-2019 (COVID-19) range from asymptomatic cases to severe respiratory failure. It is unclear whether disease severity is determined by an excess viral load or a dysregulated immune response. It is also unclear whether the severe immune response is successful in rapid viral clearance. Aim: To understand the relationship between immune response, viral clearance, and the severity of illness in unvaccinated patients suffering from COVID-19. Materials and Methods: This was a cross-sectional observational study of 65 unvaccinated patients suffering from Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) confirmed COVID-19, conducted at a dedicated COVID-19 centre, Dr. D.Y. Patil Hospital, Pimpri, Pune, Maharashtra, India. from September 2020 to April 2021. The subjects were enrolled between day 10 and day 14 of the onset of symptoms and from two distinct clinical groups. Group A consisted of 34 mild cases, and Group B consisted of 31 severe cases, classified according to the national guidelines issued by the Indian Council of Medical Research (ICMR). The clinical progress of the illness and laboratory test records were carefully reviewed. A repeat throat swab for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) RTPCR, blood levels of COVID-19 specific antibodies Immunoglobin G (IgG) and IgM, C-reactive protein (CRP), and D-dimer levels were measured on day 14 of the illness. The data were analysed using MedCalc and Epi Info software. Chi-square and Fisher’sExact tests were used to assess variables such as viral detection, antibody response, and inflammatory markers. Results: In Group A, 2/34 (5.88%) patients tested RT-PCR negative {Cycle threshold (Ct) value cut-off above 35} compared to 5/31 (16.13%) in Group B (p=0.0829). In Groups A and B, respectively, the mean antibody titers were 35390.47 and 36426.11 (p=0.7469), the mean CRP values were 4.91 (p<0.001) and 31.01 mg/dL, and the mean D-dimer levels were 895 and 2896 ng/mL (p<0.001). Conclusion: Both mild and severe COVID-19 cases had a significant antibody response which, however, did not help in viral clearance. Most patients remained RT-PCR positive on day 14 regardless of the disease severity.https://www.jcdr.net/articles/PDF/18788/63744_CE[Ra1]_F(SL)_QC&Ref(SD_SL)_PF1(VD_OM)_redo(VD_OM)_PFA(OM)_PN(OM).pdfantibodycoranavirus disease-2019 (covid-19)d-dimermarkers |
| spellingShingle | Tushar Ramesh Sahasrabudhe Harshmeet Singh Gujral Nirmala Ananthi Muthukaruppan Mahavir Satishchand Bagrecha Madhu Sudan Barthwal Shahzad Mirza Relationship between Disease Severity, Immune Response, and Viral Clearance in Unvaccinated Patients with COVID-19: A Cross-sectional Study Journal of Clinical and Diagnostic Research antibody coranavirus disease-2019 (covid-19) d-dimer markers |
| title | Relationship between Disease Severity, Immune Response, and Viral Clearance in Unvaccinated Patients with COVID-19: A Cross-sectional Study |
| title_full | Relationship between Disease Severity, Immune Response, and Viral Clearance in Unvaccinated Patients with COVID-19: A Cross-sectional Study |
| title_fullStr | Relationship between Disease Severity, Immune Response, and Viral Clearance in Unvaccinated Patients with COVID-19: A Cross-sectional Study |
| title_full_unstemmed | Relationship between Disease Severity, Immune Response, and Viral Clearance in Unvaccinated Patients with COVID-19: A Cross-sectional Study |
| title_short | Relationship between Disease Severity, Immune Response, and Viral Clearance in Unvaccinated Patients with COVID-19: A Cross-sectional Study |
| title_sort | relationship between disease severity immune response and viral clearance in unvaccinated patients with covid 19 a cross sectional study |
| topic | antibody coranavirus disease-2019 (covid-19) d-dimer markers |
| url | https://www.jcdr.net/articles/PDF/18788/63744_CE[Ra1]_F(SL)_QC&Ref(SD_SL)_PF1(VD_OM)_redo(VD_OM)_PFA(OM)_PN(OM).pdf |
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