tetano
Editor, Senior Moderator
Br J Biomed Sci
. 2026 Apr 22:83:16255.
doi: 10.3389/bjbs.2026.16255. eCollection 2026.
Clinical Utility of SARS-CoV-2 Antibody Titers in the Management of Patients With Long COVID Infected With the Omicron Variant
Marina Kawaguchi[SUP] 1 [/SUP], Yasue Sakurada[SUP] 1 [/SUP], Kazuki Tokumasu[SUP] 1 [/SUP], Yuki Otsuka[SUP] 1 [/SUP], Yasuhiro Nakano[SUP] 1 [/SUP], Yui Matsuda[SUP] 1 [/SUP], Hiroyuki Honda[SUP] 1 [/SUP], Daisuke Omura[SUP] 1 [/SUP], Nobuyoshi Matsuki[SUP] 1 [/SUP], Masanori Furukawa[SUP] 2 [/SUP], Akihito Higashikage[SUP] 2 [/SUP], Fumio Otsuka[SUP] 1 2 [/SUP]
Affiliations
Background: Long COVID (LC) presents persistent symptoms that pose a major clinical challenge. Identification of reliable biomarkers to evaluate LC pathophysiology is needed.
Objectives: To investigate whether serum S- and N-antibody titers against SARS-CoV-2 spike and nucleocapsid proteins reflect the clinical features of LC.
Methods: This retrospective observational study included patients diagnosed with Omicron variant-related LC who attended a post-COVID-19 outpatient clinic between July 2023 and November 2024 and provided informed consent for antibody testing.
Results: Among 275 patients (129 men and 146 women), 57 (21%) were unvaccinated. Median S- and N-antibody titers in vaccinated versus unvaccinated patients were 20,963 U/mL and 24.8 cut-off index (COI) versus 24 U/mL and 44.5 COI, respectively. S-antibody titers were associated with the number of vaccine doses received, whereas N-antibody titers correlated with disease severity during the acute phase of COVID-19 infection, with females having higher titers by multivariable analysis. N-antibody titers in unvaccinated patients with LC were negatively correlated with time interval from infection to clinic visit, with an estimated daily decline of 0.34% in measured N-antibody levels. Patients with LC having memory impairment had low S-antibody titers by multivariable logistic regression analysis, and low S-antibody levels were associated with reduced quality of life (QOL). Additionally, N-antibody titers positively correlated with lymphocyte counts and immunoglobulin levels.
Conclusion: Serum N-antibody titers reflect immune responses to COVID-19, although they are affected by gender differences and interval between infection and evaluation. Lower S-antibody titers were associated with brain fog symptoms and reduced QOL in patients with LC.
Keywords: COVID-19; Omicron variants; SARS-CoV-2 antibodies; brain fog; long COVID.
. 2026 Apr 22:83:16255.
doi: 10.3389/bjbs.2026.16255. eCollection 2026.
Clinical Utility of SARS-CoV-2 Antibody Titers in the Management of Patients With Long COVID Infected With the Omicron Variant
Marina Kawaguchi[SUP] 1 [/SUP], Yasue Sakurada[SUP] 1 [/SUP], Kazuki Tokumasu[SUP] 1 [/SUP], Yuki Otsuka[SUP] 1 [/SUP], Yasuhiro Nakano[SUP] 1 [/SUP], Yui Matsuda[SUP] 1 [/SUP], Hiroyuki Honda[SUP] 1 [/SUP], Daisuke Omura[SUP] 1 [/SUP], Nobuyoshi Matsuki[SUP] 1 [/SUP], Masanori Furukawa[SUP] 2 [/SUP], Akihito Higashikage[SUP] 2 [/SUP], Fumio Otsuka[SUP] 1 2 [/SUP]
Affiliations
- PMID: 42099508
- PMCID: PMC13143840
- DOI: 10.3389/bjbs.2026.16255
Background: Long COVID (LC) presents persistent symptoms that pose a major clinical challenge. Identification of reliable biomarkers to evaluate LC pathophysiology is needed.
Objectives: To investigate whether serum S- and N-antibody titers against SARS-CoV-2 spike and nucleocapsid proteins reflect the clinical features of LC.
Methods: This retrospective observational study included patients diagnosed with Omicron variant-related LC who attended a post-COVID-19 outpatient clinic between July 2023 and November 2024 and provided informed consent for antibody testing.
Results: Among 275 patients (129 men and 146 women), 57 (21%) were unvaccinated. Median S- and N-antibody titers in vaccinated versus unvaccinated patients were 20,963 U/mL and 24.8 cut-off index (COI) versus 24 U/mL and 44.5 COI, respectively. S-antibody titers were associated with the number of vaccine doses received, whereas N-antibody titers correlated with disease severity during the acute phase of COVID-19 infection, with females having higher titers by multivariable analysis. N-antibody titers in unvaccinated patients with LC were negatively correlated with time interval from infection to clinic visit, with an estimated daily decline of 0.34% in measured N-antibody levels. Patients with LC having memory impairment had low S-antibody titers by multivariable logistic regression analysis, and low S-antibody levels were associated with reduced quality of life (QOL). Additionally, N-antibody titers positively correlated with lymphocyte counts and immunoglobulin levels.
Conclusion: Serum N-antibody titers reflect immune responses to COVID-19, although they are affected by gender differences and interval between infection and evaluation. Lower S-antibody titers were associated with brain fog symptoms and reduced QOL in patients with LC.
Keywords: COVID-19; Omicron variants; SARS-CoV-2 antibodies; brain fog; long COVID.