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00925njm 22002777a 4500 dc Martin-Vicente, Maria author Almansa, Raquel author Martinez, Isidoro author Tedim, Ana P author Bustamante, Elena author Tamayo, Luis author Aldecoa, César author Gómez, José Manuel author Renedo, Gloria author Berezo, Jose Ángel author Cedeño, Jamil Antonio author Mamolar, Nuria author García Olivares, Pablo author Herrán-Monge, Rubén author Cicuendez, Ramón author Enríquez, Pedro author Ortega, Alicia author Jorge, Noelia author Doncel, Cristina author de la Fuente, Amanda author Bustamante-Munguira, Juan author Muñoz-Gómez, María José author González-Rivera, Milagros author Puertas, Carolina author Mas-Lloret, Vicente author Vazquez-Alcaraz, Monica author Perez-Garcia, Felipe author Rico-Feijoo, Jesús author Martín, Silvia author Motos, Anna author Fernandez-Barat, Laia author Eiros, José María author Domínguez-Gil, Marta author Ferrer, Ricard author Barbé, Ferrán author Trapiello, Wysali author Kelvin, David J author Bermejo-Martin, Jesús F author Resino, Salvador author Torres, Antoni author 2022-02 Background: Anti-SARS-CoV-2 S antibodies prevent viral replication. Critically ill COVID-19 patients show viral material in plasma, associated with a dysregulated host response. If these antibodies influence survival and viral dissemination in ICU-COVID patients is unknown. Patients/methods: We studied the impact of anti-SARS-CoV-2 S antibodies levels on survival, viral RNA-load in plasma, and N-antigenaemia in 92 COVID-19 patients over ICU admission. Results: Frequency of N-antigenaemia was >2.5-fold higher in absence of antibodies. Antibodies correlated inversely with viral RNA-load in plasma, representing a protective factor against mortality (adjusted HR [CI 95%], p): (S IgM [AUC ≥ 60]: 0.44 [0.22; 0.88], 0.020); (S IgG [AUC ≥ 237]: 0.31 [0.16; 0.61], <0.001). Viral RNA-load in plasma and N-antigenaemia predicted increased mortality: (N1-viral load [≥2.156 copies/ml]: 2.25 [1.16; 4.36], 0.016); (N-antigenaemia: 2.45 [1.27; 4.69], 0.007). Conclusions: Low anti-SARS-CoV-2 S antibody levels predict mortality in critical COVID-19. Our findings support that these antibodies contribute to prevent systemic dissemination of SARS-CoV-2. J Intern Med. 2022 Feb;291(2):232-240. 10.1111/joim.13386 1365-2796 0954-6820 Journal of internal medicine https://pmc.ncbi.nlm.nih.gov/articles/PMC8661581/ 34611927 https://hdl.handle.net/20.500.12105/25519 COVID-19 RNA Antibodies Antigenaemia Mortality Low anti-SARS-CoV-2 S antibody levels predict increased mortality and dissemination of viral components in the blood of critical COVID-19 patients