{"doi":"10.1101/2020.10.15.341743","title":"Predicting COVID-19 Severity with a Specific Nucleocapsid Antibody plus Disease Risk Factor Score","abstract":"Abstract 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 patient’s 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. Significance statement The COVID-19 pandemic has resulted in over two million deaths worldwide. Despite efforts to fight the virus, the disease continues to overwhelm hospitals with severely ill patients. Diagnosis of COVID-19 is readily accomplished through a multitude of reliable testing platforms; however, prognostic prediction remains elusive. To this end, we identified a short epitope from the SARS-CoV-2 nucleocapsid protein and also a disease risk factor score based upon comorbidities and age. The presence of antibodies specifically binding to this epitope plus a score cutoff can predict severe COVID-19 outcomes with 96.7% specificity.","journal":"bioRxiv (Cold Spring Harbor Laboratory)","year":2020,"id":124336,"datarank":0.20794415416798362,"base_score":1.3862943611198906,"endowment":1.3862943611198906,"self_citation_contribution":0.20794415416798362,"citation_network_contribution":0.0,"self_endowment_contribution":0.20794415416798362,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9567,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":568919,"name":"Emily C. Sanders","orcid":"0000-0003-1043-5772","position":1,"is_corresponding":false},{"id":568920,"name":"Kristin Gabriel","orcid":"0000-0002-9518-0483","position":2,"is_corresponding":false},{"id":568921,"name":"Brian Miller","orcid":"0000-0001-9186-3706","position":3,"is_corresponding":false},{"id":568922,"name":"Hariny M. Isoda","orcid":"0000-0003-0724-0667","position":4,"is_corresponding":false},{"id":568923,"name":"Gabriela S. Salcedo","orcid":"0000-0002-9794-3894","position":5,"is_corresponding":false},{"id":568924,"name":"Jason E. Garrido","orcid":"0000-0003-0741-8672","position":6,"is_corresponding":false},{"id":568925,"name":"Rebekah P. Dyer","orcid":"0000-0001-5407-3561","position":7,"is_corresponding":false},{"id":381281,"name":"Rie Nakajima","orcid":"0000-0002-1986-9086","position":8,"is_corresponding":false},{"id":458395,"name":"Aarti Jain","orcid":"0000-0002-9536-0097","position":9,"is_corresponding":false},{"id":420100,"name":"Ana-Maria Caldaruse","orcid":"0000-0002-8239-5637","position":10,"is_corresponding":false},{"id":568926,"name":"Alicia M. Santos","orcid":"0000-0002-0887-2140","position":11,"is_corresponding":false},{"id":568927,"name":"Keertna Bhuvan","orcid":"0000-0001-8760-2570","position":12,"is_corresponding":false},{"id":522461,"name":"Delia F. Tifrea","orcid":"0000-0002-7531-9337","position":13,"is_corresponding":false},{"id":568928,"name":"Joni Ricks‐Oddie","orcid":"0000-0002-9305-7692","position":14,"is_corresponding":false},{"id":104930,"name":"Philip L. Felgner","orcid":"0000-0002-4117-8505","position":15,"is_corresponding":false},{"id":347748,"name":"Robert A. Edwards","orcid":"0000-0001-9145-382X","position":16,"is_corresponding":false},{"id":569463,"name":"Sudipta Majumdar","orcid":null,"position":17,"is_corresponding":false},{"id":568929,"name":"Gregory A. Weiss","orcid":"0000-0003-0296-9846","position":18,"is_corresponding":false},{"id":568918,"name":"Sanjana Sen","orcid":"0000-0002-1535-814X","position":0,"is_corresponding":true}],"reference_count":61,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:15:07.789881Z","pmid":"33083803","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}