背景: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风险增加.虽然衰老与免疫反应受损和虚弱有关,他们的贡献和相互作用仍未得到充分研究。这项研究调查了因COVID-19住院的老年患者的炎症标志物与死亡率之间的关系以及可能因虚弱而改变的关系。
方法:数据来自三个多中心荷兰队列(COVID-OLD,CliniCo,Covid-Predict)。患者70岁或以上,因COVID-19住院,分为三个虚弱组:适合(临床虚弱评分(CFS)1-3),脆弱前(CFS4-5),和脆弱(CFS6-9)。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率(NLR),基线时测量血小板/淋巴细胞比率(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系。
结果:共有1697例患者来自COVID-OLD,656来自Covid-Predict,和CliniCo的574。每个队列的中位年龄为79、77和78岁。医院死亡率为33%,在这三个队列中,分别为27%和39%,分别。在所有三个队列中,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,或者SII,在脆弱的群体中相似。较高的CRP水平与所有虚弱组的住院死亡风险增加有关。在所有队列中(OR(95%CI),2.88(2.20-3.78),3.15(1.95-5.16),和3.28(1.87-5.92)),和虚弱没有改变炎症标志物和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总体结局的一个重要因素,我们的研究表明,老年虚弱患者与健康患者相比死亡率升高的风险可能不能通过炎症反应的差异来解释.
BACKGROUND: 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).
CONCLUSIONS: 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.