- Sen, S;
- Sanders, EC;
- Gabriel, KN;
- Miller, BM;
- Isoda, HM;
- Salcedo, GS;
- Garrido, JE;
- Dyer, RP;
- Nakajima, R;
- Jain, A;
- Caldaruse, A-M;
- Santos, AM;
- Bhuvan, K;
- Tifrea, DF;
- Ricks-Oddie, JL;
- Felgner, PL;
- Edwards, RA;
- Majumdar, S;
- Weiss, GA
Effective methods for predicting COVID-19 disease trajectories are urgently needed. Here, ELISA and coronavirus antigen microarray (COVAM) analysis mapped antibody epitopes in the plasma of COVID-19 patients (n = 86) experiencing a wide-range of disease states. The experiments identified antibodies to a 21-residue epitope from nucleocapsid (termed Ep9) associated with severe disease, including admission to the ICU, requirement for ventilators, or death. Importantly, anti-Ep9 antibodies can be detected within six days post-symptom onset and sometimes within one day. Furthermore, anti-Ep9 antibodies correlate with various comorbidities and hallmarks of immune hyperactivity. We introduce a simple-to-calculate, disease risk factor score to quantitate each patients comorbidities and age. For patients with anti-Ep9 antibodies, scores above 3.0 predict more severe disease outcomes with a 13.42 Likelihood Ratio (96.7% specificity). The results lay the groundwork for a new type of COVID-19 prognostic to allow early identification and triage of high-risk patients. Such information could guide more effective therapeutic intervention.