Determinants of Antibody Reactivity in COVID-19: A Case-Control Study in a Middle Eastern Cohort

Understanding the determinants of humoral immunity following COVID-19 infection is essential for guiding vaccination and public health strategies. This study aimed to investigate the association between cycle threshold (Ct) values and SARS-CoV-2-specific antibody reactivity 1 month after recovery in a Middle Eastern cohort, and to identify other contributing factors.

A case-control study was conducted among COVID-19 patients registered in the Qatar Biobank between March and September 2020. Cases were defined as individuals with detectable anti-SARS-CoV-2 antibodies 1-month post-recovery, while controls lacked antibody reactivity. Demographics, comorbidities, Ct values, and disease severity were collected at baseline. Logistic regression was used to analyze factors associated with antibody reactivity, with results adjusted for key covariates.

Among 225 participants, 177 (78.7%) exhibited reactive anti-SARS-CoV-2 IgG antibodies 1-month post-recovery. Among participants with reactive antibodies, 74.0% were from severe and critical cases. Lower Ct values (< 20), indicating higher viral load, were associated with increased odds of antibody reactivity (OR 2.03, 95% CI 0.97-4.24, p = 0.059). Male gender was significantly associated with antibody reactivity (OR 3.24, 95% CI 1.53-6.89, p = 0.002), while disease severity and BCG vaccination status showed no significant association.

Ct values and male gender may serve as significant predictors of antibody-mediated immunity to COVID-19 infection. Larger studies are needed to validate these findings, identify vulnerable individuals who may benefit from booster vaccination, and explore their relevance to other respiratory pathogens.