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Antibody Level Predicts the Clinical Course of Breakthrough Infection of COVID-19 Caused by Delta and Omicron Variants: A Prospective Cross-Sectional Study

 Min Hyung Kim  ;  Yooju Nam  ;  Nak Hoon Son  ;  Namwoo Heo  ;  Bongyoung Kim  ;  Eawha Kang  ;  Areum Shin  ;  Andrew Jihoon Yang  ;  Yoon Soo Park  ;  Heejung Kim  ;  Taeyoung Kyong  ;  Yong Chan Kim 
 OPEN FORUM INFECTIOUS DISEASES, Vol.9(7) : ofac262, 2022-07 
Journal Title
Issue Date
COVID-19 breakthrough infection ; Delta variant ; Omicron variant ; antibody level
Background: Omicron variant viruses spread rapidly, even in individuals with high vaccination rates. This study aimed to determine the utility of the antibody against spike protein level as a predictor of the disease course of coronavirus disease 2019 (COVID-19) in vaccinated patients.

Methods: Between December 11, 2021, and February 10, 2022, we performed a prospective observational cohort study in South Korea, which included patients infected with Delta and Omicron variants. A multivariable logistic regression analysis to determine the association between antibody levels and outcomes was conducted. The relationship between antibody levels and cycle threshold (Ct) values was confirmed using a generalized linear model.

Results: From 106 vaccinated patients (39 Delta and 67 Omicron), the geometric mean titers of antibodies in patients with fever (≥37.5°C), hypoxia (≤94% of SpO2), pneumonia, C-reactive protein (CRP) elevation (>8 mg/L), or lymphopenia (<1100 cells/μL) were 1201.5 U/mL, 98.8 U/mL, 774.1 U/mL, 1335.1 U/mL, and 1032.2 U/mL, respectively. Increased antibody levels were associated with a decrease in the occurrence of fever (adjusted odds ratio [aOR], 0.23; 95% CI, 0.12-0.51), hypoxia (aOR, 0.23; 95% CI, 0.08-0.7), CRP elevation (aOR, 0.52; 95% CI, 0.29-0.0.94), and lymphopenia (aOR, 0.57; 95% CI, 0.33-0.98). Ct values showed a positive correlation between antibody levels (P = .02).

Conclusions: Antibody levels are predictive of the clinical course of COVID-19 in vaccinated patients with Delta and Omicron variant infections. Our data highlight the need for concentrated efforts to monitor patients with severe acute respiratory syndrome coronavirus 2 infection who are at risk of low antibody levels.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Others (기타) > 1. Journal Papers
Yonsei Authors
Kang, Ea Wha(강이화)
Kyong, Tae Young(경태영) ORCID logo https://orcid.org/0000-0001-5846-7808
Kim, Min Hyung(김민형)
Kim, Yong Chan(김용찬)
Kim, Heejung(김희정) ORCID logo https://orcid.org/0000-0002-0190-703X
Nam, Yooju(남유주)
Park, Yoon Soo(박윤수)
Shin, Areum(신아름)
Yang, Andrew Jihoon(양지훈) ORCID logo https://orcid.org/0000-0002-1635-4036
Heo, Namwoo(허남우)
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