The age again in the eye of the COVID-19 storm: evidence-based decision making
Carmen Martín, Aurora Jurado, Cristina Abad‐Molina, Antonio Orduña, Oscar Yarce, Ana Navas, Vanesa Cunill, Danilo Escobar, Francisco Boix, Sergio Burillo‐Sanz, María C. Vegas-Sánchez, Yesenia Jiménez, Josefa Melero, Marta Aguilar, Oana Irina Sobieschi, Marcos López‐Hoyos, Gonzalo Ocejo-Vinyals, David San Segundo, Delia Almeida, Silvia Medina, Luis Fernández, Esther Vergara, Bibiana Quirant‐Sánchez, Eva Martínez‐Cáceres, Marc Boiges, Marta Fuentes Alonso, Laura Esparcia-Pinedo, Celia López‐Sanz, Javier Muñoz-Vico, Serafín López-Palmero, Antonio Trujillo, Paula Álvarez, Álvaro Prada, David Monzón, Jesús Ontañón, Francisco M. Marco, Sergio Castro Mora, Ricardo Rojo, Gema González‐Martínez, María T. Martínez-Saavedra, Juana Gil-Herrera, Sergi Cantenys-Molina, M. Hernández, Janire Perurena-Prieto, Beatriz Rodríguez‐Bayona, Alba Martínez, Esther Ocaña, Juan Molina
Abstract
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.