The age again in the eye of the COVID-19 storm: evidence-based decision making.
Por:
Martín MC, Jurado A, Abad-Molina C, Orduña A, Yarce O, Navas AM, Cunill V, Escobar D, Boix F, Burillo-Sanz S, Vegas-Sánchez MC, Jiménez-de Las Pozas Y, Melero J, Aguilar M, Sobieschi OI, López-Hoyos M, Ocejo-Vinyals G, San Segundo D, Almeida D, Medina S, Fernández L, Vergara E, Quirant B, Martínez-Cáceres E, Boiges M, Alonso M, Esparcia-Pinedo L, López-Sanz C, Muñoz-Vico J, López-Palmero S, Trujillo A, Álvarez P, Prada Á, Monzón D, Ontañón J, Marco FM, Mora S, Rojo R, González-Martínez G, Martínez-Saavedra MT, Gil-Herrera J, Cantenys-Molina S, Hernández M, Perurena-Prieto J, Rodríguez-Bayona B, Martínez A, Ocaña E and Molina J
Publicada:
20 may 2021
Ahead of Print:
20 may 2021
Resumen:
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.
Filiaciones:
Martín MC:
Centro de Hemoterapia y Hemodonación de Castilla y León, Valladolid, Spain
Jurado A:
Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Avd. Menéndez Pidal s/n, 14004, Córdoba, Spain.
Abad-Molina C:
Department of Microbiology and Immunology, Hospital Clínico Universitario, Valladolid, Spain
Orduña A:
Department of Microbiology and Immunology, Hospital Clínico Universitario, Valladolid, Spain
Yarce O:
Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Avd. Menéndez Pidal s/n, 14004, Córdoba, Spain
Navas AM:
Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Avd. Menéndez Pidal s/n, 14004, Córdoba, Spain
Cunill V:
Department of Immunology, Hospital Universitario Son Espases-Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
Escobar D:
Department of Immunology, Hospital Universitario Son Espases-Human Immunopathology Research Laboratory, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
Boix F:
Department of Immunology, Hospital Clínico Universitario, Salamanca, Spain
Burillo-Sanz S:
Department of Immunology, Hospital Clínico Universitario, Salamanca, Spain
Vegas-Sánchez MC:
Department of Immunology, Fundación Jiménez Díaz, Madrid, Spain
Jiménez-de Las Pozas Y:
Department of Immunology, Fundación Jiménez Díaz, Madrid, Spain
Melero J:
Department of Immunology, Hospital Universitario de Badajoz, Badajoz, Spain
Aguilar M:
Department of Immunology, Hospital Universitario de Badajoz, Badajoz, Spain
Sobieschi OI:
Department of Immunology, Hospital Universitario de Badajoz, Badajoz, Spain
López-Hoyos M:
Department of Immunology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
Ocejo-Vinyals G:
Department of Immunology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
San Segundo D:
Department of Immunology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
Almeida D:
Laboratory of Immunology, Complejo Hospitalario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
Medina S:
Laboratory of Immunology, Complejo Hospitalario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
Fernández L:
Laboratoy of Immunology and Genetics, Hospital San Pedro de Alcántara, Cáceres, Spain
Vergara E:
Laboratoy of Immunology and Genetics, Hospital San Pedro de Alcántara, Cáceres, Spain
Quirant B:
Department of Immunology, Hospital Germans Trias i Pujols, Barcelona, Spain
Martínez-Cáceres E:
Department of Immunology, Hospital Germans Trias i Pujols, Barcelona, Spain
Boiges M:
Department of Immunology, Hospital Germans Trias i Pujols, Barcelona, Spain
Alonso M:
Department of Immunology, Hospital de Cruces, Baracaldo, Spain
Esparcia-Pinedo L:
Department of Immunology, Hospital Universitario La Princesa, Madrid, Spain
López-Sanz C:
Department of Immunology, Hospital Universitario La Princesa, Madrid, Spain
Muñoz-Vico J:
Department of Immunology, Hospital Torrecárdenas, Almería, Spain
López-Palmero S:
Department of Immunology, Hospital Torrecárdenas, Almería, Spain
Trujillo A:
Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Avd. Menéndez Pidal s/n, 14004, Córdoba, Spain
Álvarez P:
Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Avd. Menéndez Pidal s/n, 14004, Córdoba, Spain
Prada Á:
Department of Immunology, Hospital de Donostia, San Sebastián, Spain
Monzón D:
Department of Immunology, Hospital de Donostia, San Sebastián, Spain
Ontañón J:
Unit of Immunology, Hospital General Universitario, Albacete, Spain
:
Laboratory Unit, Hospital General, Alicante, Spain
Mora S:
Laboratory Unit, Hospital General, Alicante, Spain
Rojo R:
Department of Immunology, Complejo Hospitalario, La Coruña, Spain
González-Martínez G:
Unit of Immunology, Hospital Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
Martínez-Saavedra MT:
Unit of Immunology, Hospital Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
Gil-Herrera J:
Department of Immunology, Hospital General Universitario e Instituto de Investigación Sanitaria, "Gregorio Marañón", Madrid, Spain
Cantenys-Molina S:
Department of Immunology, Hospital General Universitario e Instituto de Investigación Sanitaria, "Gregorio Marañón", Madrid, Spain
Hernández M:
Department of Immunology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
Perurena-Prieto J:
Department of Immunology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
Rodríguez-Bayona B:
Laboratory Unit, Hospital Juan Ramón Jiménez, Huelva, Spain
Martínez A:
Laboratory Unit, Complejo Hospitalario, Jaén, Spain
Ocaña E:
Laboratory Unit, Complejo Hospitalario, Jaén, Spain
Molina J:
Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Avd. Menéndez Pidal s/n, 14004, Córdoba, Spain
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