Li Yunhui, Chen Yuan, Liang Jing, Wang Yajie
Department of Clinical Laboratory, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Front Cell Infect Microbiol. 2024 Nov 29;14:1450196. doi: 10.3389/fcimb.2024.1450196. eCollection 2024.
Advanced age is a primary risk factor for adverse COVID-19 outcomes, potentially attributed to immunosenescence and dysregulated inflammatory responses. In the post-pandemic era, with containment measures lifted, the elderly remain particularly susceptible, highlighting the need for intensified focus on immune health management.
A total of 281 elderly patients were enrolled in this study and categorized based on their clinical status at the time of admission into three groups: non-severe (n = 212), severe survivors (n = 49), and severe non-survivors (n = 20). Binary logistic regression analysis was employed to identify independent risk factors associated with disease severity and in-hospital outcomes. The diagnostic performance of risk factors was assessed using the receiver operating characteristic (ROC) curves. Kaplan-Meier survival analysis and log-rank test were utilized to compare the 30-day survival rates. Furthermore, the transcriptomic data of CD4 T cells were extracted from Gene Expression Omnibus (GEO) database. Gene Set Enrichment Analysis (GSEA) was applied to reveal biological processes and pathways involved.
In the comparison between severe and non-severe COVID-19 cases, significant elevations were observed in the neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), and Serum Amyloid A (SAA) levels, concurrent with a notable reduction in CD8 T cells, CD4 T cells, natural killer (NK) cells, and monocytes (all < 0.05). CD4 T cells (OR: 0.997 [0.995-1.000], <0.05) and NLR (OR: 1.03 [1.001-1.060], <0.05) were independent risk factors affecting disease severity. The diagnostic accuracy for COVID-19 severity, as measured by the area under the curve (AUC) for CD4 T cells and NLR, was 0.715 (95% CI: 0.645-0.784) and 0.741 (95% CI: 0.675-0.807), respectively. Moreover, patients with elevated NLR or IL-6 levels at admission exhibited significantly shorter survival times. Gene Set Enrichment Analysis (GSEA) revealed several biological pathways that are implicated in the regulation of immune responses and metabolic processes.
Lymphocytopenia and the cytokine storm onset are significant predictors of an unfavorable prognosis in elderly patients. The decrease in CD4 T cells among elderly patients is detrimental to disease recovery, and the biological pathways regulated by these cells could potentially heighten vulnerability to SARS-CoV-2 infection, thereby exacerbating the development of associated complications.
高龄是新冠病毒病（COVID-19）不良结局的主要危险因素，这可能归因于免疫衰老和炎症反应失调。在疫情后时代，随着防控措施的解除，老年人仍然特别易感，这凸显了加强免疫健康管理的必要性。
本研究共纳入281例老年患者，并根据入院时的临床状态将其分为三组：非重症组（n = 212）、重症存活组（n = 49）和重症非存活组（n = 20）。采用二元逻辑回归分析来确定与疾病严重程度和院内结局相关的独立危险因素。使用受试者工作特征（ROC）曲线评估危险因素的诊断性能。采用Kaplan-Meier生存分析和对数秩检验比较30天生存率。此外，从基因表达综合数据库（GEO）中提取CD4 T细胞的转录组数据。应用基因集富集分析（GSEA）来揭示所涉及的生物学过程和通路。
在重症与非重症COVID-19病例的比较中，中性粒细胞与淋巴细胞比值（NLR）、C反应蛋白（CRP）和血清淀粉样蛋白A（SAA）水平显著升高，同时CD8 T细胞、CD4 T细胞、自然杀伤（NK）细胞和单核细胞显著减少（均P<0.05）。CD4 T细胞（比值比：0.997[0.9951.000]，P<0.05）和NLR（比值比：1.03[1.0011.060]，P<0.05）是影响疾病严重程度的独立危险因素。以CD4 T细胞和NLR的曲线下面积（AUC）衡量的COVID-19严重程度的诊断准确性分别为0.715（95%置信区间：0.6450.784）和0.741（95%置信区间：0.6750.
