COVID-19 : Age, Interleukin-6, C-reactive protein, and lymphocytes as key clues from a multicentre retrospective study
Jurado, Aurora (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Martín, María C. (Centro de Hemoterapia y Hemodonación de Castilla y León)
Abad-Molina, Cristina (Hospital Clínic i Provincial de Barcelona)
Orduña, Antonio (Hospital Clínic i Provincial de Barcelona)
Martínez, Alba (Complejo Hospitalario de Jaén)
Ocaña, Esther (Complejo Hospitalario de Jaén)
Yarce, Oscar (Instituto Maimónides de Investigación Biomédica de Córdoba)
Navas, Ana M. (Instituto Maimónides de Investigación Biomédica de Córdoba)
Trujillo, Antonio (Instituto Maimónides de Investigación Biomédica de Córdoba)
Fernández, Luis (Hospital San Pedro de Alcántara)
Vergara, Esther (Hospital San Pedro de Alcántara)
Rodríguez, Beatriz (Hospital Juan Ramón Jiménez (Huelva))
Quirant, Bibiana (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Martínez Cáceres, Eva María (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Hernández, Manuel (Hospital Universitari Vall d'Hebron)
Perurena-Prieto, Janire (Hospital Universitari Vall d'Hebron)
Gil, Juana (Hospital General Universitario Gregorio Marañón)
Cantenys, Sergi (Hospital General Universitario Gregorio Marañón)
González-Martínez, Gema (Hospital Universitario Insular-Materno Infantil. Unit of Immunology)
Martínez-Saavedra, María T. (Hospital Universitario Insular-Materno Infantil. Unit of Immunology)
Rojo, Ricardo (Complejo Hospitalario A Coruña)
Marco, Francisco M. (Hospital General. Laboratory Unit)
Mora, Sergio (Hospital General. Laboratory Unit)
Ontañón, Jesús (Hospital General Universitario (Albacete))
López-Hoyos, Marcos (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Ocejo-Vinyals, Gonzalo (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Melero, Josefa (Hospital Infanta Cristina)
Aguilar, Marta (Hospital Infanta Cristina)
Almeida, Delia (Hospital Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife))
Medina, Silvia (Hospital Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife))
Vegas, María C. (Fundación Jiménez Díaz. Department of Immunology)
Jiménez, Yesenia (Fundación Jiménez Díaz. Department of Immunology)
Prada, Álvaro (Hospital Universitario de Donostia (Sant Sebastià, País Basc))
Monzón, David (Hospital Universitario de Donostia (Sant Sebastià, País Basc))
Boix, Francisco (Hospital Clínic i Provincial de Barcelona)
Cunill, Vanesa (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Molina, Juan (Instituto Maimónides de Investigación Biomédica de Córdoba)

Data:	2020
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Severe acute respiratory syndrome coronavirus 2 ; COVID-19 ; Immunosenescence ; Immunity ; Renin-angiotensin system ; ACE2 ; Interleukin-6 ; C-reactive protein ; Lymphocytes ; Spain
Publicat a:	Immunity and Ageing, Vol. 17 (august 2020) , ISSN 1742-4933

DOI: 10.1186/s12979-020-00194-w
PMID: 32802142

15 p, 1.2 MB

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