炎症标志物与老年 COVID-19 患者衰弱和住院死亡率的关系。
The association of inflammatory markers with frailty and in-hospital mortality in older COVID-19 patients.
机构信息
Department of Internal Medicine, Section of Geriatrics and Gerontology, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands.
Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity (AII), University of Amsterdam, Amsterdam, the Netherlands.; Division of Allergy and Clinical Immunology, Department of Internal Medicine, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands; Department of Immunology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands.
出版信息
Exp Gerontol. 2024 Oct 1;195:112534. doi: 10.1016/j.exger.2024.112534. Epub 2024 Aug 6.
INTRODUCTION
During the COVID19 pandemic, older patients hospitalized for COVID-19 exhibited an increased mortality risk compared to younger patients. While ageing is associated with compromised immune responses and frailty, their contributions and interplay remain understudied. This study investigated the association between inflammatory markers and mortality and potential modification by frailty among older patients hospitalized for COVID-19.
METHODS
Data were from three multicenter Dutch cohorts (COVID-OLD, CliniCo, Covid-Predict). Patients were 70 years or older, hospitalized for COVID-19and categorized into three frailty groups: fit (Clinical frailty score (CFS) 1-3), pre-frail (CFS 4-5), and frail (CFS 6-9). Immunological markers (lymphocyte count, neutrophil count, C-reactive protein, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic inflammation index (SII)) were measured at baseline. Associations with in hospital mortality were examined using logistic regression.
RESULTS
A total of 1697 patients were included from COVID-OLD, 656 from Covid-Predict, and 574 from CliniCo. The median age was 79, 77, and 78 years for each cohort. Hospital mortality rates were 33 %, 27 % and 39 % in the three cohorts, respectively. A lower CRP was associated with a higher frailty score in all three cohorts (all p < 0.01). Lymphocyte count, neutrophil count, NLR, PLR, or SII, were similar across frailty groups. Higher CRP levels were associated with increased in-hospital mortality risk across all frailty groups, across all cohorts (OR (95 % CI), 2.88 (2.20-3.78), 3.15 (1.95-5.16), and 3.28 (1.87-5.92)), and frailty did not modify the association between inflammatory markers and in-hospital mortality (all p-interaction>0.05).
CONCLUSION
While frailty is a significant factor in determining overall outcomes in older patients, our study suggests that the elevated risk of mortality in older patients with frailty compared to fit patients is likely not explained by difference in inflammatory responses.
介绍
在 COVID19 大流行期间，与年轻患者相比，因 COVID-19 住院的老年患者的死亡率风险增加。虽然衰老与免疫反应受损和虚弱有关，但它们的贡献和相互作用仍未得到充分研究。本研究调查了炎症标志物与死亡率之间的关联，以及在因 COVID-19 住院的老年患者中，虚弱对死亡率的潜在影响。
方法
数据来自三个多中心荷兰队列（COVID-OLD、CliniCo、Covid-Predict）。患者年龄在 70 岁或以上，因 COVID-19 住院，并分为三个虚弱组：健康（临床虚弱评分（CFS）1-3）、虚弱前期（CFS 4-5）和虚弱（CFS 6-9）。在基线时测量免疫标志物（淋巴细胞计数、中性粒细胞计数、C 反应蛋白、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和全身炎症指数（SII））。使用逻辑回归检查与住院死亡率的关联。
结果
COVID-OLD 纳入了 1697 例患者，Covid-Predict 纳入了 656 例，CliniCo 纳入了 574 例。每个队列的中位年龄分别为 79、77 和 78 岁。三个队列的住院死亡率分别为 33%、27%和 39%。在三个队列中，较低的 CRP 与较高的虚弱评分相关（均 p<0.01）。淋巴细胞计数、中性粒细胞计数、NLR、PLR 或 SII 在虚弱组之间相似。在所有虚弱组中，较高的 CRP 水平与住院死亡率增加相关，在所有队列中均如此（OR（95%CI），2.88（2.20-3.78）、3.15（1.95-5.16）和 3.28（1.87-5.92）），并且虚弱并未改变炎症标志物与住院死亡率之间的关联（所有 p 交互作用>0.05）。
结论
虽然虚弱是决定老年患者整体结局的重要因素，但我们的研究表明，与健康患者相比，虚弱的老年患者死亡率风险增加，这可能不是由于炎症反应的差异所致。
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