Immunity & Ageing (May 2021)

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

  • María C. Martín,
  • Aurora Jurado,
  • Cristina Abad-Molina,
  • Antonio Orduña,
  • Oscar Yarce,
  • Ana M. Navas,
  • Vanesa Cunill,
  • Danilo Escobar,
  • Francisco Boix,
  • Sergio Burillo-Sanz,
  • María C. Vegas-Sánchez,
  • Yesenia Jiménez-de las Pozas,
  • Josefa Melero,
  • Marta Aguilar,
  • Oana Irina Sobieschi,
  • Marcos López-Hoyos,
  • Gonzalo Ocejo-Vinyals,
  • David San Segundo,
  • Delia Almeida,
  • Silvia Medina,
  • Luis Fernández,
  • Esther Vergara,
  • Bibiana Quirant,
  • Eva Martínez-Cáceres,
  • Marc Boiges,
  • Marta Alonso,
  • Laura Esparcia-Pinedo,
  • Celia López-Sanz,
  • Javier Muñoz-Vico,
  • Serafín López-Palmero,
  • Antonio Trujillo,
  • Paula Álvarez,
  • Álvaro Prada,
  • David Monzón,
  • Jesús Ontañón,
  • Francisco M. Marco,
  • Sergio Mora,
  • Ricardo Rojo,
  • Gema González-Martínez,
  • María T. Martínez-Saavedra,
  • Juana Gil-Herrera,
  • Sergi Cantenys-Molina,
  • Manuel Hernández,
  • Janire Perurena-Prieto,
  • Beatriz Rodríguez-Bayona,
  • Alba Martínez,
  • Esther Ocaña,
  • Juan Molina

DOI
https://doi.org/10.1186/s12979-021-00237-w
Journal volume & issue
Vol. 18, no. 1
pp. 1 – 18

Abstract

Read online

Abstract Background One 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. Results Concerning 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. Conclusion Age 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.

Keywords