TY - JOUR
T1 - The association of inflammatory markers with frailty and in-hospital mortality in older COVID-19 patients
AU - Tran Van Hoi, Estelle
AU - Appelman, Brent
AU - Mooijaart, Simon
AU - Dalm, Virgil A.S.H.
AU - Polinder Bos, Harmke A.
AU - van Heemst, Diana
AU - van Raaij, Bas F.M.
AU - Noordam, Raymond
AU - Kuranova, Anna
AU - Hoogerwerf, Jacobien J.
AU - Peeters, Geeske
AU - Smorenberg, Annemieke
AU - Mooijaart, Simon P.
AU - Gussekloo, Jacobijn
AU - Polinder Bos, Harmke A.
AU - Moons, Karel G.M.
AU - van Smeden, Maarten
AU - Melis, René J.F.
AU - Elders, Petra J.M.
AU - Festen, Jan
AU - van der Linden, Carolien M.J.
AU - Jansen, Steffy W.M.
AU - Willems, Hanna C.
AU - van der Bol, Jessica M.
AU - Rusch, Daisy
AU - van den Oever, Niels C.Gritters
AU - Simsek, Suat
AU - van Osch, Frits H.M.
AU - de Kruif, Martijn D.
AU - Douma, Renée A.
AU - Moeniralam, Hazra
AU - Brinkman, Kees
AU - Bokhizzou, Nejma
AU - Leavis, Helen
AU - Beudel, Martijn
AU - Abbink, Evertine J.
AU - Jacobs-Peters, Jeannette
AU - Dofferhoff, Ton
AU - Kerckhoffs, Angele
AU - van der Maat, Josephine
AU - Netea, Mihai
AU - Slieker, Kitty
AU - Veerman, Karin
AU - CliniCo study
AU - COOP consortium
AU - COVID-OLD study
AU - Covid-Predict study
N1 - Funding Information:
This work was supported by Zorg Onderzoek Nederland en Medische Wetenschappen (ZonMw) to the COVID-19 Outcomes in Older People (COOP) study (project number 10430102110005) under the COVID-19 program. ZonMW had no role in data analysis or reporting.
Publisher Copyright:
© 2024 The Author(s)
PY - 2024/10/1
Y1 - 2024/10/1
N2 - 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.
AB - 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.
KW - Ageing
KW - COVID-19
KW - Frailty
KW - Immunosenescence
KW - Inflammation
U2 - 10.1016/j.exger.2024.112534
DO - 10.1016/j.exger.2024.112534
M3 - Article
SN - 0531-5565
VL - 195
JO - Experimental Gerontology
JF - Experimental Gerontology
M1 - 112534
ER -