The age again in the eye of the COVID-19 storm: evidence-based decision making

Immunity & Ageing

María C. Martín¹  Oscar Yarce²  Juan Molina²  Ana M. Navas²  Antonio Trujillo²  Aurora Jurado²  Paula Álvarez²  Ricardo Rojo³  Yesenia Jiménez-de las Pozas⁴  María C. Vegas-Sánchez⁴  Francisco Boix⁵  Sergio Burillo-Sanz⁵  Sergi Cantenys-Molina⁶  Juana Gil-Herrera⁶  Marc Boiges⁷  Bibiana Quirant⁷  Eva Martínez-Cáceres⁷  Serafín López-Palmero⁸  Javier Muñoz-Vico⁸  Laura Esparcia-Pinedo⁹  Celia López-Sanz⁹  Marcos López-Hoyos^1,10  David San Segundo^1,10  Gonzalo Ocejo-Vinyals^1,10  Vanesa Cunill^1,11  Danilo Escobar^1,11  Manuel Hernández^1,12  Janire Perurena-Prieto^1,12  Oana Irina Sobieschi^1,13  Marta Aguilar^1,13  Josefa Melero^1,13  Marta Alonso^1,14  David Monzón^1,15  Álvaro Prada^1,15  Cristina Abad-Molina^1,16  Antonio Orduña^1,16  Alba Martínez^1,17  Esther Ocaña^1,17  Sergio Mora^1,18  Francisco M. Marco^1,18  Beatriz Rodríguez-Bayona^1,19  Silvia Medina^2,20  Delia Almeida^2,20  Esther Vergara^2,21  Luis Fernández^2,21  Jesús Ontañón^2,22  Gema González-Martínez^2,23  María T. Martínez-Saavedra^2,23 

[1] Centro de Hemoterapia y Hemodonación de Castilla y León, Valladolid, Spain;Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Avd. Menéndez Pidal s/n, 14004, Córdoba, Spain;Department of Immunology, Complejo Hospitalario, La Coruña, Spain;Department of Immunology, Fundación Jiménez Díaz, Madrid, Spain;Department of Immunology, Hospital Clínico Universitario, Salamanca, Spain;Department of Immunology, Hospital General Universitario e Instituto de Investigación Sanitaria, “Gregorio Marañón”, Madrid, Spain;Department of Immunology, Hospital Germans Trias i Pujols, Barcelona, Spain;Department of Immunology, Hospital Torrecárdenas, Almería, Spain;Department of Immunology, Hospital Universitario La Princesa, Madrid, Spain;Department of Immunology, Hospital Universitario Marqués de Valdecilla, Santander, Spain;Department of Immunology, Hospital Universitario Son Espases-Human Immunopathology Research Laboratory, Institut d’Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain;Department of Immunology, Hospital Universitario Vall d’Hebron, Barcelona, Spain;Department of Immunology, Hospital Universitario de Badajoz, Badajoz, Spain;Department of Immunology, Hospital de Cruces, Baracaldo, Spain;Department of Immunology, Hospital de Donostia, San Sebastián, Spain;Department of Microbiology and Immunology, Hospital Clínico Universitario, Valladolid, Spain;Laboratory Unit, Complejo Hospitalario, Jaén, Spain;Laboratory Unit, Hospital General, Alicante, Spain;Laboratory Unit, Hospital Juan Ramón Jiménez, Huelva, Spain;Laboratory of Immunology, Complejo Hospitalario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain;Laboratoy of Immunology and Genetics, Hospital San Pedro de Alcántara, Cáceres, Spain;Unit of Immunology, Hospital General Universitario, Albacete, Spain;Unit of Immunology, Hospital Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain;

关键词: Severe acute respiratory syndrome coronavirus 2;    COVID-19;    Immunosenescence;    Lockdown;    Immunity;    Renin-angiotensin-aldosterone system inhibitors;    Cut-off points;    Lymphocytes;    Area under the curve;   

DOI  :  10.1186/s12979-021-00237-w

来源: Springer

【 摘 要 】

BackgroundOne hundred fifty million contagions, more than 3 million deaths and little more than 1 year of COVID-19 have changed our lives and our health management systems forever. Ageing is known to be one of the significant determinants for COVID-19 severity. Two main reasons underlie this: immunosenescence and age correlation with main COVID-19 comorbidities such as hypertension or dyslipidaemia. This study has two aims. The first is to obtain cut-off points for laboratory parameters that can help us in clinical decision-making. The second one is to analyse the effect of pandemic lockdown on epidemiological, clinical, and laboratory parameters concerning the severity of the COVID-19. For these purposes, 257 of SARSCoV2 inpatients during pandemic confinement were included in this study. Moreover, 584 case records from a previously analysed series, were compared with the present study data.ResultsConcerning the characteristics of lockdown series, mild cases accounted for 14.4, 54.1% were moderate and 31.5%, severe. There were 32.5% of home contagions, 26.3% community transmissions, 22.5% nursing home contagions, and 8.8% corresponding to frontline worker contagions regarding epidemiological features. Age > 60 and male sex are hereby confirmed as severity determinants. Equally, higher severity was significantly associated with higher IL6, CRP, ferritin, LDH, and leukocyte counts, and a lower percentage of lymphocyte, CD4 and CD8 count. Comparing this cohort with a previous 584-cases series, mild cases were less than those analysed in the first moment of the pandemic and dyslipidaemia became more frequent than before. IL-6, CRP and LDH values above 69 pg/mL, 97 mg/L and 328 U/L respectively, as well as a CD4 T-cell count below 535 cells/μL, were the best cut-offs predicting severity since these parameters offered reliable areas under the curve.ConclusionAge and sex together with selected laboratory parameters on admission can help us predict COVID-19 severity and, therefore, make clinical and resource management decisions. Demographic features associated with lockdown might affect the homogeneity of the data and the robustness of the results.

【 授权许可】

CC BY