Effect of Third and Fourth mRNA-Based Booster Vaccinations on SARS-CoV-2 Neutralizing Antibody Titer Formation, Risk Factors for Non-Response, and Outcome after SARS-CoV-2 Omicron Breakthrough Infections in Patients on Chronic Hemodialysis: A Prospective Multicenter Cohort Study
Abstract
:1. Introduction
2. Methods
2.1. Statistical Outcome Parameter, Cohort, and Case Series Definitions
2.2. SARS-CoV-2 Antibody Test Assays
2.3. SARS-CoV-2 PCR-Test Assay
2.4. Statistical Analyses
3. Results
3.1. Effect of a Third Booster Vaccination on SARS-CoV-2 IgG Antibodies and Their Neutralizing Capacity (A)
3.2. Risk Factor Analysis for Immunological Non-Response (B)
3.3. Sensitivity Analysis
3.4. Effect of ≥4 Booster Vaccinations on SARS-CoV-2 IgG Antibodies and Their Neutralizing Capacity in Low- and/or Non-Responders (C)
3.5. Clinical Course of Breakthrough Infections in 20 Patients on Chronic Hemodialysis (D)
4. Discussion
Major Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Categories | Post Second Vaccination (No, %) | Post Third Vaccination (No, %) | Somers‘d | |||
---|---|---|---|---|---|---|
IgG | >433 | 84 | 54.9% | 127 | 83.0% | <0.001 |
216–433 | 10 | 6.5% | 10 | 6.5% | ||
<216 | 59 | 38.6% | 16 | 10.5% | ||
% inhibition | >66 | 99 | 64.7% | 136 | 88.9% | 0.003 |
33–66 | 23 | 15.0% | 7 | 4.6% | ||
<33 | 31 | 20.3% | 10 | 6.5% |
(a) | |||||
Variable | RC-B | p-Level | Exponent-B | 95%-CI | |
boost to lab (days) | 0.016 | 0.082 | 1.016 | 0.998 | 1.034 |
Age (years) | 0.034 | 0.200 | 1.035 | 0.982 | 1.090 |
Active malignancy | 1.142 | 0.300 | 3.134 | 0.362 | 27.170 |
(b) | |||||
Variable | RC-B | p-Level | Exponent-B | 95%-CI | |
boost to lab (days) | 0.008 | 0.287 | 1.008 | 0.993 | 1.023 |
Age (years) | 0.064 | 0.004 | 1.066 | 1.020 | 1.114 |
Active malignancy | 0.458 | 0.617 | 1.581 | 0.263 | 9.494 |
isMedication | 2.112 | 0.002 | 8.267 | 2.206 | 30.975 |
No. | Age | BMI | Diabetes | pKTx | Vintage | Vaccination | isMeds | aTumor | Albumin | Kt/V | IgG | nTiter |
---|---|---|---|---|---|---|---|---|---|---|---|---|
1. | 50–55 | 23.0 | / | Yes | 1.59 | 5 times mRNA | ldST/Tacrolimus | / | 2843 | 1.1 | >433 | 87 |
2. | 85–90 | 32.4 | / | / | 0.93 | 4 times mRNA | ldST | Yes | 3116 | 1.1 | 0 | 5 |
3. | 65–70 | 27.7 | / | / | 3.70 | 4 times mRNA | / | / | 3624 | 1.4 | >433 | 94 |
4. | 95–100 | 30.6 | / | / | 1.77 | 1 vector + 3 mRNA | ldST | / | 3526 | 0.8 | 211 | 88 |
5. | 60–65 | 31.3 | / | / | 1.11 | 4 times mRNA | ST/Cyclophosphamide | / | 3481 | 1.1 | >433 | 98 |
6. | 85–90 | 25.7 | / | / | 2.38 | 4 times mRNA | / | / | 3829 | 0.9 | >433 | 100 |
7. | 80–85 | 23.7 | Yes | / | 5.82 | 4 times mRNA | / | / | 3069 | 1.0 | >433 | 100 |
8. | 75–80 | 23.8 | / | / | 6.12 | 4 times mRNA | ST/Daratumumab | Yes | 3450 | 1.3 | >433 | 99 |
9. | 80–85 | 20.0 | Yes | / | 5.91 | 4 times mRNA | / | / | 3330 | 1.4 | >433 | 58 |
10. | 90–95 | 22.2 | / | / | 2.69 | 4 times mRNA | ldST | / | 3333 | 0.9 | >433 | 83 |
No. | Age | BMI | Diabetes | pKTx | Vintage | Vaccination | isMeds | IgG | nTiter | CT | Remission/Days | Course |
---|---|---|---|---|---|---|---|---|---|---|---|---|
1. | 50–55 | 22 | No | Yes | 7.2 | 3 times mRNA | ldST | >433 | 100 | 21 | 18 | Mild |
2. | 55–60 | 31 | No | Yes | 10.5 | 3 times mRNA | no | >433 | 100 | 17 | 14 | Mild |
3. | 55–60 | 29 | No | No | 2.1 | 3 times mRNA | no | 0 | <30 | 17 | 16 | Mild |
4. | 30–35 | 19 | No | Yes | 5.8 | 2 times mRNA | no | >433 | 98 | 22 | 7 | Mild |
5. | 60–65 | 35 | Yes | No | 0.4 | 2 times mRNA | no | 70 | 48 | 9 | 29 | Mild |
6. | 70–75 | 28 | Yes | No | 1.6 | wild, 2 times mRNA | no | >433 | 84 | 15 | 12 | Mild |
7. | 50–55 | 32 | Yes | No | 4.0 | 3 times mRNA | no | >433 | 99 | 13 | 8 | Mild |
8. | 35–40 | 31 | Yes | Yes | 2.1 | 3 times mRNA | no | >433 | 100 | 18 | 13 | Mild |
9. | 80–85 | 19 | No | No | 3.4 | 3 times mRNA | no | >433 | 100 | 18 | 13 | Mild |
10. | 30–35 | 20 | Yes | No | 0.7 | 3 times mRNA | no | >433 | 97 | 14 | 15 | Mild |
11. | 80–85 | 24 | No | No | 0.9 | 4 times mRNA | no | >433 | 99 | 16 | 14 | Mild |
12. | 70–75 | 24 | No | No | 4.4 | 3 times mRNA | no | >433 | 100 | 16 | 12 | Mild |
13. | 75–80 | 20 | No | No | 7.9 | 3 times mRNA | no | >433 | 99 | 13 | 11 | Mild |
14. | 60–65 | 30 | Yes | No | 0.8 | 3 times mRNA | ldST | 372 | 51 | 19 | 8 | Mild |
15. | 60–65 | 25 | No | No | 3.8 | 3 times mRNA | No | >433 | 98 | 21 | 7 | Mild |
16. | 50–55 | 27 | No | Yes | 1.6 | 4 times mRNA | No | >433 | 97 | 18 | 10 | Mild |
17. | 70–75 | 23 | No | No | 14.7 | 3 times mRNA | No | >433 | 99 | 16 | 12 | Mild |
18. | 60–65 | 32 | No | No | 1.1 | 3 times mRNA | ldST | >433 | 98 | 19 | 12 | Mild |
19. | 75–80 | 25 | No | No | 8.7 | 3 times mRNA | No | >433 | 100 | 12 | 8 | Mild |
20. | 80–85 | 19 | Yes | No | 0.6 | 1 time mRNA | ST | 0 | 0 | 14 | 12 | Mild |
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Tillmann, F.-P.; Figiel, L.; Ricken, J.; Still, H.; Korte, C.; Plaßmann, G.; Harth, A.; Jörres, A.; von Landenberg, P. Effect of Third and Fourth mRNA-Based Booster Vaccinations on SARS-CoV-2 Neutralizing Antibody Titer Formation, Risk Factors for Non-Response, and Outcome after SARS-CoV-2 Omicron Breakthrough Infections in Patients on Chronic Hemodialysis: A Prospective Multicenter Cohort Study. J. Clin. Med. 2022, 11, 3187. https://doi.org/10.3390/jcm11113187
Tillmann F-P, Figiel L, Ricken J, Still H, Korte C, Plaßmann G, Harth A, Jörres A, von Landenberg P. Effect of Third and Fourth mRNA-Based Booster Vaccinations on SARS-CoV-2 Neutralizing Antibody Titer Formation, Risk Factors for Non-Response, and Outcome after SARS-CoV-2 Omicron Breakthrough Infections in Patients on Chronic Hemodialysis: A Prospective Multicenter Cohort Study. Journal of Clinical Medicine. 2022; 11(11):3187. https://doi.org/10.3390/jcm11113187
Chicago/Turabian StyleTillmann, Frank-Peter, Lars Figiel, Johannes Ricken, Hermann Still, Christoph Korte, Grete Plaßmann, Ana Harth, Achim Jörres, and Philipp von Landenberg. 2022. "Effect of Third and Fourth mRNA-Based Booster Vaccinations on SARS-CoV-2 Neutralizing Antibody Titer Formation, Risk Factors for Non-Response, and Outcome after SARS-CoV-2 Omicron Breakthrough Infections in Patients on Chronic Hemodialysis: A Prospective Multicenter Cohort Study" Journal of Clinical Medicine 11, no. 11: 3187. https://doi.org/10.3390/jcm11113187