Otwarty dostęp

Critical Care Workers Have Lower Seroprevalence of SARS-CoV-2 IgG Compared with Non-patient Facing Staff in First Wave of COVID19

Helen E. Baxendale
Helen E. Baxendale
, 
David Wells
David Wells
, 
Jessica Gronlund
Jessica Gronlund
, 
Angalee Nadesalingham
Angalee Nadesalingham
, 
Mina Paloniemi
Mina Paloniemi
, 
George Carnell
George Carnell
, 
Paul Tonks
Paul Tonks
, 
Lourdes Ceron-Gutierrez
Lourdes Ceron-Gutierrez
, 
Soraya Ebrahimi
Soraya Ebrahimi
, 
Ashleigh Sayer
Ashleigh Sayer
, 
John A.G. Briggs
John A.G. Briggs
, 
Xiaoli Ziong
Xiaoli Ziong
, 
James A Nathan
James A Nathan
, 
Guinevere Grice
Guinevere Grice
, 
Leo C James
Leo C James
, 
Jakub Luptak
Jakub Luptak
, 
Sumita Pai
Sumita Pai
, 
Jonathan L Heeney
Jonathan L Heeney
, 
Sara Lear
Sara Lear
 oraz 
Rainer Doffinger
Rainer Doffinger
   | 05 sie 2021
The Journal of Critical Care Medicine's Cover Image
O artykule
Poprzedni artykuł
Następny artykuł
Zacytuj
Article Category: Research article
Data publikacji: 05 sie 2021
Zakres stron: 199 - 210
Otrzymano: 21 gru 2020
Przyjęty: 28 maj 2021
DOI: https://doi.org/10.2478/jccm-2021-0018
Słowa kluczowe
© 2021 Helen E. Baxendale, David Wells, Jessica Gronlund, Angalee Nadesalingham, Mina Paloniemi, George Carnell, Paul Tonks, Lourdes Ceron-Gutierrez, Soraya Ebrahimi, Ashleigh Sayer, John A.G. Briggs, Xiaoli Ziong, James A Nathan, Guinevere Grice, Leo C James, Jakub Luptak, Sumita Pai, Jonathan L Heeney, Sara Lear, Rainer Doffinger, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1

Training data set used in the support vector machine (SVM) and applied to classification of HCW serostatus and sensitivity/specificity analysis from PCR confirmed SARS-CoV-2 positive patients and pre-pandemic negative control samples are shown. A. Luminex values (MFI) show the relationship between (a) N and S, (b) N and RBD, (c) S and RBD in COVID-19 patients. (d) Illustrates how the SVM identifies cut off between HCW classified seropositive (orange) and seronegative (blue) samples taking into account the MFI binding to each antigen tested. The background colour indicates whether a sample at that location would be classified as seropositive (pale orange) or seronegative (pale blue). The classification is made based on all antigens at once, i.e. there is no single cut off point for any single antigen. The cut off shown here assumes the average pre-pandemic anti RBD response. For lower RBD responses the blue orange cut off is moved down and left. B. Receiver Operator Curves (ROC) for individual N, S and RBD antigens demonstrates the sensitivity and specificity of the Luminex assay with area under the curve (AUC) value embedded in each ROC analysis.
Training data set used in the support vector machine (SVM) and applied to classification of HCW serostatus and sensitivity/specificity analysis from PCR confirmed SARS-CoV-2 positive patients and pre-pandemic negative control samples are shown. A. Luminex values (MFI) show the relationship between (a) N and S, (b) N and RBD, (c) S and RBD in COVID-19 patients. (d) Illustrates how the SVM identifies cut off between HCW classified seropositive (orange) and seronegative (blue) samples taking into account the MFI binding to each antigen tested. The background colour indicates whether a sample at that location would be classified as seropositive (pale orange) or seronegative (pale blue). The classification is made based on all antigens at once, i.e. there is no single cut off point for any single antigen. The cut off shown here assumes the average pre-pandemic anti RBD response. For lower RBD responses the blue orange cut off is moved down and left. B. Receiver Operator Curves (ROC) for individual N, S and RBD antigens demonstrates the sensitivity and specificity of the Luminex assay with area under the curve (AUC) value embedded in each ROC analysis.

Fig. 2

Serostatus Classification. The mean fluorescent intensity (MFI) by Luminex of staff serum IgG binding to SARS-CoV-2 proteins N, S and RBD, showing the relationship of binding between the three proteins : (A) N and S, (B) S-RBD and N, (C) S and S-RBD. (D) shows the number of staff classified as seropositive or seronegative by the trained SVM. Serostatus is indicated by colour in all four panels: blue: seronegative; orange: seropositive.
Serostatus Classification. The mean fluorescent intensity (MFI) by Luminex of staff serum IgG binding to SARS-CoV-2 proteins N, S and RBD, showing the relationship of binding between the three proteins : (A) N and S, (B) S-RBD and N, (C) S and S-RBD. (D) shows the number of staff classified as seropositive or seronegative by the trained SVM. Serostatus is indicated by colour in all four panels: blue: seronegative; orange: seropositive.

Fig. 3

Proportion of staff being classified as seropositive based on working location. (Proportion determined by Binomial regression. Significance determined by Wald-Z test. *p=0.017.
Proportion of staff being classified as seropositive based on working location. (Proportion determined by Binomial regression. Significance determined by Wald-Z test. *p=0.017.

Fig. 4

Proportion of seronegative and seropositive staff reporting specific symptoms. Bars in orange indicate the proportion of seropositive staff with a symptom while bars in turquoise indicate seronegative staff proportions. Symptoms are ordered by difference in proportion between seropositive and seronegative staff. * *p=0.031; ***p<0.001.
Proportion of seronegative and seropositive staff reporting specific symptoms. Bars in orange indicate the proportion of seropositive staff with a symptom while bars in turquoise indicate seronegative staff proportions. Symptoms are ordered by difference in proportion between seropositive and seronegative staff. * *p=0.031; ***p<0.001.

Fig. 5

Symptom severity score by age and sex. a. Stacked histogram of seropositive staff age split by sex and coloured by severity of infection. b. Probability of disease severity based on age and sex of seropositive staff. Severity of infection is indicated by colour; grey is class 1 (asymptomatic), pale orange is class 2, and dark orange is class 3 or 4 (grouped due to small sample size).
Symptom severity score by age and sex. a. Stacked histogram of seropositive staff age split by sex and coloured by severity of infection. b. Probability of disease severity based on age and sex of seropositive staff. Severity of infection is indicated by colour; grey is class 1 (asymptomatic), pale orange is class 2, and dark orange is class 3 or 4 (grouped due to small sample size).

Cohort demographic for age, sex, ethnicity and work location and by serostatus by multiplex (N=498 classified). Values: N= (% of total and of cohort by demographic classification to nearest whole number). Age: years.*p=0.017 : age of seropositive and seronegative cohort (MW-U).

Total (%) Seropositive (%) Seronegative (%)
Number recruited 500 70 (14) 428 (86)
Age (yrs, median with IQR) 42 (33-51) 40 (32-50) 47 (36-53)*
Sex male 146 (29) 20 (14) 126 (86)
female 352 (70) 50 (14) 302 (86)
Ethnicity group 1:white 390 (78) 45 (12) 345 (88)
2:mixed 16 (3) 4 (25) 12 (75)
3:asian 79 (16) 16 (20) 63 (80)
4:black 11 (2) 2 (18) 9 (82)
5: other 1 (0.2) 0 1 (0.2)
NA 3 (1) 0
Work location Critical Care patient facing 126 (25) 10 (7.9) 116 (92)
Non-Critical Care patient facing 284 (57) 40 (14) 244 (86)
Non-patient facing 63 (13) 12 (19) 51 (81)
NA 27 (5)

PCR Swab Positive and Symptom Severity Score by Serostatus. N= (% of total and of each cohort by severity score).

Total Seropositive Seronegative
PCR positive nasal swab 12 (2) 9 (75) 3 (25)
Symptom Severity Score 1: asymptomatic 275 (55) 17 (6) 258 (94)
2: mild 195 (39) 39 (20) 156 (80)
3: moderate 26 (5) 9 (35) 17 (65)
4: severe 1 (0.2) 1 0
NA 3 (0.6)
eISSN:
2393-1817
Język:
Angielski
Częstotliwość wydawania:
4 razy w roku
Dziedziny czasopisma:
Medicine, Clinical Medicine, Internal Medicine, other, Surgery, Anaesthesiology, Emergency Medicine and Intensive-Care Medicine
Kanał RSS czasopisma