tetano
Editor, Senior Moderator
Immun Ageing
. 2020 Aug 14;17:22.
doi: 10.1186/s12979-020-00194-w. eCollection 2020.
COVID-19: age, Interleukin-6, C-reactive protein, and lymphocytes as key clues from a multicentre retrospective study
Aurora Jurado[SUP] #[/SUP][SUP] 1 [/SUP], Mar?a C Mart?n[SUP] #[/SUP][SUP] 2 [/SUP], Cristina Abad-Molina[SUP] 3 [/SUP], Antonio Ordu?a[SUP] 3 [/SUP], Alba Mart?nez[SUP] 4 [/SUP], Esther Oca?a[SUP] 4 [/SUP], Oscar Yarce[SUP] 1 [/SUP], Ana M Navas[SUP] 1 [/SUP], Antonio Trujillo[SUP] 1 [/SUP], Luis Fern?ndez[SUP] 5 [/SUP], Esther Vergara[SUP] 5 [/SUP], Beatriz Rodr?guez[SUP] 6 [/SUP], Bibiana Quirant[SUP] 7 [/SUP], Eva Mart?nez-C?ceres[SUP] 7 [/SUP], Manuel Hern?ndez[SUP] 8 [/SUP], Janire Perurena-Prieto[SUP] 8 [/SUP], Juana Gil[SUP] 9 [/SUP], Sergi Cantenys[SUP] 9 [/SUP], Gema Gonz?lez-Mart?nez[SUP] 10 [/SUP], Mar?a T Mart?nez-Saavedra[SUP] 10 [/SUP], Ricardo Rojo[SUP] 11 [/SUP], Francisco M Marco[SUP] 12 [/SUP], Sergio Mora[SUP] 12 [/SUP], Jes?s Onta??n[SUP] 13 [/SUP], Marcos L?pez-Hoyos[SUP] 14 [/SUP], Gonzalo Ocejo-Vinyals[SUP] 14 [/SUP], Josefa Melero[SUP] 15 [/SUP], Marta Aguilar[SUP] 15 [/SUP], Delia Almeida[SUP] 16 [/SUP], Silvia Medina[SUP] 16 [/SUP], Mar?a C Vegas[SUP] 17 [/SUP], Yesenia Jim?nez[SUP] 17 [/SUP], ?lvaro Prada[SUP] 18 [/SUP], David Monz?n[SUP] 18 [/SUP], Francisco Boix[SUP] 19 [/SUP], Vanesa Cunill[SUP] 20 [/SUP], Juan Molina[SUP] 1 [/SUP]
Affiliations
Abstract
Background: The SARS-CoV-2 infection has widely spread to become the greatest public health challenge to date, the COVID-19 pandemic. Different fatality rates among countries are probably due to non-standardized records being carried out by local health authorities. The Spanish case-fatality rate is 11.22%, far higher than those reported in Asia or by other European countries. A multicentre retrospective study of demographic, clinical, laboratory and immunological features of 584 Spanish COVID-19 hospitalized patients and their outcomes was performed. The use of renin-angiotensin system blockers was also analysed as a risk factor.
Results: In this study, 27.4% of cases presented a mild course, 42.1% a moderate one and for 30.5% of cases, the course was severe. Ages ranged from 18 to 98 (average 63). Almost 60 % (59.8%) of patients were male. Interleukin 6 was higher as severity increased. On the other hand, CD8 lymphocyte count was significantly lower as severity grew and subpopulations CD4, CD8, CD19, and NK showed concordant lowering trends. Severity-related natural killer percent descents were evidenced just within aged cases. A significant severity-related decrease of CD4 lymphocytes was found in males. The use of angiotensin-converting enzyme inhibitors was associated with a better prognosis. The angiotensin II receptor blocker use was associated with a more severe course.
Conclusions: Age and age-related comorbidities, such as dyslipidaemia, hypertension or diabetes, determined more frequent severe forms of the disease in this study than in previous literature cohorts. Our cases are older than those so far reported and the clinical course of the disease is found to be impaired by age. Immunosenescence might be therefore a suitable explanation for the hampering of immune system effectors. The adaptive immunity would become exhausted and a strong but ineffective and almost deleterious innate response would account for COVID-19 severity. Angiotensin-converting enzyme inhibitors used by hypertensive patients have a protective effect in regards to COVID-19 severity in our series. Conversely, patients on angiotensin II receptor blockers showed a severer disease.
Keywords: ACE2; C-reactive protein; COVID-19; Immunity; Immunosenescence; Interleukin-6; Lymphocytes; Renin-angiotensin system; Severe acute respiratory syndrome coronavirus 2; Spain
. 2020 Aug 14;17:22.
doi: 10.1186/s12979-020-00194-w. eCollection 2020.
COVID-19: age, Interleukin-6, C-reactive protein, and lymphocytes as key clues from a multicentre retrospective study
Aurora Jurado[SUP] #[/SUP][SUP] 1 [/SUP], Mar?a C Mart?n[SUP] #[/SUP][SUP] 2 [/SUP], Cristina Abad-Molina[SUP] 3 [/SUP], Antonio Ordu?a[SUP] 3 [/SUP], Alba Mart?nez[SUP] 4 [/SUP], Esther Oca?a[SUP] 4 [/SUP], Oscar Yarce[SUP] 1 [/SUP], Ana M Navas[SUP] 1 [/SUP], Antonio Trujillo[SUP] 1 [/SUP], Luis Fern?ndez[SUP] 5 [/SUP], Esther Vergara[SUP] 5 [/SUP], Beatriz Rodr?guez[SUP] 6 [/SUP], Bibiana Quirant[SUP] 7 [/SUP], Eva Mart?nez-C?ceres[SUP] 7 [/SUP], Manuel Hern?ndez[SUP] 8 [/SUP], Janire Perurena-Prieto[SUP] 8 [/SUP], Juana Gil[SUP] 9 [/SUP], Sergi Cantenys[SUP] 9 [/SUP], Gema Gonz?lez-Mart?nez[SUP] 10 [/SUP], Mar?a T Mart?nez-Saavedra[SUP] 10 [/SUP], Ricardo Rojo[SUP] 11 [/SUP], Francisco M Marco[SUP] 12 [/SUP], Sergio Mora[SUP] 12 [/SUP], Jes?s Onta??n[SUP] 13 [/SUP], Marcos L?pez-Hoyos[SUP] 14 [/SUP], Gonzalo Ocejo-Vinyals[SUP] 14 [/SUP], Josefa Melero[SUP] 15 [/SUP], Marta Aguilar[SUP] 15 [/SUP], Delia Almeida[SUP] 16 [/SUP], Silvia Medina[SUP] 16 [/SUP], Mar?a C Vegas[SUP] 17 [/SUP], Yesenia Jim?nez[SUP] 17 [/SUP], ?lvaro Prada[SUP] 18 [/SUP], David Monz?n[SUP] 18 [/SUP], Francisco Boix[SUP] 19 [/SUP], Vanesa Cunill[SUP] 20 [/SUP], Juan Molina[SUP] 1 [/SUP]
Affiliations
- PMID: 32802142
- PMCID: PMC7426672
- DOI: 10.1186/s12979-020-00194-w
Abstract
Background: The SARS-CoV-2 infection has widely spread to become the greatest public health challenge to date, the COVID-19 pandemic. Different fatality rates among countries are probably due to non-standardized records being carried out by local health authorities. The Spanish case-fatality rate is 11.22%, far higher than those reported in Asia or by other European countries. A multicentre retrospective study of demographic, clinical, laboratory and immunological features of 584 Spanish COVID-19 hospitalized patients and their outcomes was performed. The use of renin-angiotensin system blockers was also analysed as a risk factor.
Results: In this study, 27.4% of cases presented a mild course, 42.1% a moderate one and for 30.5% of cases, the course was severe. Ages ranged from 18 to 98 (average 63). Almost 60 % (59.8%) of patients were male. Interleukin 6 was higher as severity increased. On the other hand, CD8 lymphocyte count was significantly lower as severity grew and subpopulations CD4, CD8, CD19, and NK showed concordant lowering trends. Severity-related natural killer percent descents were evidenced just within aged cases. A significant severity-related decrease of CD4 lymphocytes was found in males. The use of angiotensin-converting enzyme inhibitors was associated with a better prognosis. The angiotensin II receptor blocker use was associated with a more severe course.
Conclusions: Age and age-related comorbidities, such as dyslipidaemia, hypertension or diabetes, determined more frequent severe forms of the disease in this study than in previous literature cohorts. Our cases are older than those so far reported and the clinical course of the disease is found to be impaired by age. Immunosenescence might be therefore a suitable explanation for the hampering of immune system effectors. The adaptive immunity would become exhausted and a strong but ineffective and almost deleterious innate response would account for COVID-19 severity. Angiotensin-converting enzyme inhibitors used by hypertensive patients have a protective effect in regards to COVID-19 severity in our series. Conversely, patients on angiotensin II receptor blockers showed a severer disease.
Keywords: ACE2; C-reactive protein; COVID-19; Immunity; Immunosenescence; Interleukin-6; Lymphocytes; Renin-angiotensin system; Severe acute respiratory syndrome coronavirus 2; Spain