418 - Comparison of the Abbott SARS-CoV-2 IgG and DiaSorin LIASON SARS-CoV-2 S1/S2 IgG Antibody Assays

Background: The Abbott Laboratories SARS-CoV-2 IgG assay and the DiaSorin LIASON SARS-CoV-2 S1/S2 IgG assay are both chemiluminescent immunoassays that qualitatively detect IgG antibodies against SARS-CoV-2 antigens. The Abbott assay detects IgG against the viral nucleocapsid (N) protein, while the DiaSorin assay uses antigen derived from the viral spike (S) protein. Here we evaluate the performance of these two assays at our institution.

Methods: 45 patient samples (serum or plasma) were tested for anti-SARS-CoV-2 IgG by both the Abbott and DiaSorin assays. The samples were previously characterized at a national reference laboratory using the Abbott assay or by an in-house PCR-based test for SARS-CoV-2 RNA. Samples yielding discordant results across platforms were further tested using the EUROIMMUN Anti-SARS-CoV-2 ELISA (IgG) assay at the reference laboratory.

Results: 22 samples tested negative for SARS-CoV-2 by the reference lab Abbott assay, and 23 tested positive by the same reference lab test (n = 13) or by an in-house PCR-based test (n = 10). The 22 samples characterized as negative again tested negative by both the Abbott (in-house) and DiaSorin assays (100% NPA). Among the 23 samples characterized as positive, all 23 tested positive by the Abbott assay (100% PPA), while only 15 tested positive by the DiaSorin assay (65% PPA). For each of the 8 discordant cases, samples were further tested by EUROIMMUN assay, which targets the S protein; 7 of the 8 samples tested negative by this assay, in agreement with the DiaSorin test results. Thus, for the discordant cases, testing for IgG against N (in-house and reference lab Abbott assays) gave positive results, while testing for IgG against S (DiaSorin and EUROIMMUN assays) mostly gave negative results.

Conclusion: These findings highlight the importance of the differences between various SARS-CoV-2 antibody tests, and providers should be aware of the specific antigenic target(s) in each test. Selection of a specific assay may depend on the need to assess past exposure to SARS-CoV-2 (for which a nucleocapsid target may be more sensitive) or to detect neutralizing antibodies (for which a spike target may be more relevant). This also has implications for disease surveillance as reliance on anti-spike antibodies alone may underestimate infection prevalence.