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Background <p>An infection with severe acute respiratory syndrome coronavirus (SARS-CoV-2) may significantly contribute to the pathogenesis of autoimmune rheumatic diseases; interactions between the virus and defence mechanisms may promote the development of autoimmune processes. Studies have reported elevated levels of autoimmune antibodies in patients with Coronavirus Disease-19 (COVID-19), however, the exact prevalence remains poorly undocumented. This study aims to evaluate the prevalence of autoantibodies in COVID-19 patients compared to unaffected individuals.</p> Methods <p>Electronic searches were conducted using the Cochrane Library, PubMed, Embase, Web of Science, Chinese Biological Medicine Database (CBM), China National Knowledge Infrastructure (CNKI), WANFANG, and Chinese Weipu (VIP). The case-control studies investigating the presence of autoantibodies in the serum of COVID-19 patients and control subjects published were included in this meta-analysis. The search covered November 2019, to December 2025. Studies were rigorously screened based on predefined inclusion and exclusion criteria. Quality assessment was performed using a modified version of the Newcastle-Ottawa scale (NOS). The odds ratios (ORs) for autoantibody seropositivity were calculated using RevMan 5.3. Sensitivity analysis was conducted to evaluate the stability results, and publication bias was assessed using Egger’s test and funnel plot.</p> Results <p>A total of 17 studies involving 1652 COVID-19 patients and 1455 control subjects met eligibility criteria for inclusion in the meta-analysis. The overall OR for antinuclear antibodies (ANAs) was 2.90 [95% confidence interval (CI): 1.36–6.18], for anti-cardiolipin antibodies (ACAs) was 3.34 (95% CI: 2.14–5.21), for anti-β2-glycoprotein 1 antibodies (anti-β2GP1) was 1.87 (95% CI: 1.00–3.49) and that for anti-cytoplasmic neutrophil antibodies (ANCAs) was 8.49 (95% CI: 3.38–21.33). Among the 11 studies assessing ANAs, the quality varied widely, resulting in considerable heterogeneity in the meta-analysis results. Heterogeneity across studies on ANAs may partially stem from differences in assay manufacturers as well as variations in the working cut-off dilution used for IIF. Egger’s test reports indicated statistically significant publication bias among the included studies on ANAs.</p> Conclusions <p>This study suggests a higher seroprevalence of autoantibodies, including ANAs, ACAs, anti-β2GP1, and ANCAs in COVID-19 patients compared to control subjects. The findings identified a possible association between SARS-CoV-2 infection and autoantibody positivity, contributing to the understanding of COVID-19’s role in autoimmune processes.</p> Clinical trial number <p>Not applicable.</p>

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Prevalence of autoantibody responses in COVID-19 patients: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月23日

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  • Dan Xu,
  • Minjie Zhang,
  • Ying Zhao,
  • Weiwei Liang,
  • Yi Zhang,
  • Lijiang Fang

摘要

Background

An infection with severe acute respiratory syndrome coronavirus (SARS-CoV-2) may significantly contribute to the pathogenesis of autoimmune rheumatic diseases; interactions between the virus and defence mechanisms may promote the development of autoimmune processes. Studies have reported elevated levels of autoimmune antibodies in patients with Coronavirus Disease-19 (COVID-19), however, the exact prevalence remains poorly undocumented. This study aims to evaluate the prevalence of autoantibodies in COVID-19 patients compared to unaffected individuals.

Methods

Electronic searches were conducted using the Cochrane Library, PubMed, Embase, Web of Science, Chinese Biological Medicine Database (CBM), China National Knowledge Infrastructure (CNKI), WANFANG, and Chinese Weipu (VIP). The case-control studies investigating the presence of autoantibodies in the serum of COVID-19 patients and control subjects published were included in this meta-analysis. The search covered November 2019, to December 2025. Studies were rigorously screened based on predefined inclusion and exclusion criteria. Quality assessment was performed using a modified version of the Newcastle-Ottawa scale (NOS). The odds ratios (ORs) for autoantibody seropositivity were calculated using RevMan 5.3. Sensitivity analysis was conducted to evaluate the stability results, and publication bias was assessed using Egger’s test and funnel plot.

Results

A total of 17 studies involving 1652 COVID-19 patients and 1455 control subjects met eligibility criteria for inclusion in the meta-analysis. The overall OR for antinuclear antibodies (ANAs) was 2.90 [95% confidence interval (CI): 1.36–6.18], for anti-cardiolipin antibodies (ACAs) was 3.34 (95% CI: 2.14–5.21), for anti-β2-glycoprotein 1 antibodies (anti-β2GP1) was 1.87 (95% CI: 1.00–3.49) and that for anti-cytoplasmic neutrophil antibodies (ANCAs) was 8.49 (95% CI: 3.38–21.33). Among the 11 studies assessing ANAs, the quality varied widely, resulting in considerable heterogeneity in the meta-analysis results. Heterogeneity across studies on ANAs may partially stem from differences in assay manufacturers as well as variations in the working cut-off dilution used for IIF. Egger’s test reports indicated statistically significant publication bias among the included studies on ANAs.

Conclusions

This study suggests a higher seroprevalence of autoantibodies, including ANAs, ACAs, anti-β2GP1, and ANCAs in COVID-19 patients compared to control subjects. The findings identified a possible association between SARS-CoV-2 infection and autoantibody positivity, contributing to the understanding of COVID-19’s role in autoimmune processes.

Clinical trial number

Not applicable.