• Danila De Vito, Agostino Di Ciaula, Vincenzo O Palmieri, Paolo Trerotoli, Angela Maria Vittoria Larocca, Maria Teresa Montagna, and Piero Portincasa.
• Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Medical School, University of Bari Aldo Moro. Electronic address: danila.devito@uniba.it.
• Eur. J. Intern. Med. 2022 Apr 1; 98: 77-82.

BackgroundCOVID-19 pandemic has generated a million deaths worldwide. The efficiency of the immune system can modulate individual vulnerability with variable outcomes. However, the relationships between disease severity and the titer of antibodies produced against SARS-CoV-2 in non-vaccinated, recently infected subjects need to be fully elucidated.MethodsA total of 99 patients admitted to a COVID-unit underwent clinical assessment and measurement of serum levels of anti-spike protein (S1) IgM, and anti-nucleocapsid protein IgG. Patients were stratified according to the clinical outcome (i.e., discharged at home or in-hospital death).ResultsFollowing hospitalization, 18 died during the hospital stay. They were older, had lymphopenia, a higher co-morbidity rate, and longer hospital stay than 81 patients who were discharged after healing. Patients in this latter group had, at hospital admittance, 7.9-fold higher serum concentration of IgM, and 2.4-fold higher IgG levels. Multivariate Cox regression models indicated age and anti-nucleocapsid protein IgG concentration at admission as independently associated with the risk of in-hospital death.ConclusionsAn efficient immunological response during the early phase of COVID-19 protects from mortality, irrespective of age. Advanced age is a critical risk factor for poor outcome in infected subjects. Further studies must explore potential therapeutic strategies able to restore a valid functional humoral immunity in elderly patients with poor antibody response during the early stage of COVID-19 infection.Copyright © 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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