Sars-Cov-2 antibody titer 3 months post-vaccination is affected by age, gender, smoking and vitamin D

  1. Anastasia Parthymou
  2. Evagelia E Habeos
  3. George I Habeos
  4. Apostolos Deligakis
  5. Ektoras Livieratos
  6. Markos Marangos
  7. Dionysios V Chartoumpekis

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Abstract

Context

Vaccination against Sars-Cov-2 is in full swing during COVID-19 pandemic. One of the efficient methods to evaluate response to vaccination is the assessment of humoral immunity by measuring Sars-Cov-2 antibody titer. Identification of factors that affect the humoral response is important so as to ameliorate the responses to vaccination or identify vulnerable groups that may need vaccination boosters.

Objective

We investigated the effect of anthropometric parameters (age, BMI), smoking, diabetes, statin use hypertension and levels of 25(OH)D and DHEAS to the Sars-Cov-2 antibody titer.

Methods

In this longitudinal observational cohort study 712 subjects were tested for Sars-Cov-2 antibodies 3 months after the second dose of BNT162b2 vaccine. Multiple linear regression analysis was performed to identify which factors are associated with the antibody titer.

Results

We identified age to be negatively associated with antibody titer (p=0.0073) and male sex (p=0.0008). However, interaction of age and gender was significant (p<0.0001) highlighting the finding that only after the age of 40 years men had lower antibody levels than women. DHEAS, an aging marker, was not associated with the antibody titer. Smoking was also associated with low antibody titer (p=0.0008) while overweight or obese subjects did not have different antibody response compared to normal weight individuals. Although diabetic and hypertensive subjects trended towards lower antibody titer, this association was not statistically significant. Replete vitamin D levels were associated with higher antibody titers (p=0.00422).

Conclusions

Age, male sex and smoking negatively affects antibody titer while 25(OH)D is associated with increased Sars-Cov-2 antibody titers.

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  1. ScreenIT

    SciScore for 10.1101/2021.09.01.21262913: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Design, setting and study population: This is a longitudinal observational cohort study (ClinicalTrials.gov Identifier: NCT04954651, approved by the University Hospital of Patras Ethics Committee, approval ID 99-25/2/202) in healthcare units of western Greece.
    Consent: Participation was based on informed written consent.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Quantitative determination of antibodies (including IgG) to SARS CoV 2 spike (S) protein receptor binding domain (RBD) was performed using the Elecsys® Anti-SARS-CoV-2 S immunoassay (
    S) protein receptor binding domain (RBD
    suggested: None
    To assess which factors affect the SARS-Cov-2 antibody titer, multiple linear regression modelling was performed with log-transformed antibody titer as a continuous dependent variable and using stepwise entry criteria of p<0.05.
    SARS-Cov-2
    suggested: None
    Age, sex, smoking, hypertension, diabetes, statin use, body mass index (BMI), DHEAS and Vitamin D were checked for linear association with the log-transformed antibody titer and if no linear association was found for a variable, this variable was converted to categorical using quartiles (DHEAS and vitamin D) or pre-existing categories for BMI (underweight; <18.5, normal weight; 18.5-24.9, overweight; 25-29.9, obesity; >30).
    BMI
    suggested: None
    Software and Algorithms
    SentencesResources
    Blood samples were drawn before vaccination, 3 weeks and 3 months after the second dose of vaccination with BNT162b2 vaccine (BioNTech and Pfizer) as part of the national COVID-19 vaccination program in Greece.
    BioNTech
    suggested: None
    GraphPad Prism version 9.0.0 for Windows (GraphPad Software, San Diego, CA, USA) was used for all the statistical analyses and graphs generation.
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)
    4 graphs were generated using Microsoft Excel 365
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations of our study include the reliance on questionnaire for anthropometric measurements and the reporting of diabetes and hypertension. The final multiple linear regression model that was generated has an adjusted r2=0.14 (Table 3), meaning that this model explains roughly only 14% of the variance in our data and indicates that other parameters, besides the ones already taken into consideration, should be included so as to further improve the model. Advantages of our study include the relatively high number of participants, the strict criterion of excluding all subjects that at least one parameter (of those examined) is missing, the use of a multiple linear regression model taking into account all parameters examined in parallel. Last but not least, to the best of our knowledge, this was the first study to examine DHEAS and 25(OH)D levels as potential modulators of the SARS-COV-2 antibody titer response post-vaccination.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04954651RecruitingAssessment of the Immunization Levels Against Sars-Cov2 Viru…

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.09.01.21262913v1 on medRxiv