Ontology highlight
ABSTRACT: Background
Coronavirus disease 2019 (COVID-19)-induced mortality occurs predominantly in older patients. Several immunomodulating therapies seem less beneficial in these patients. The biological substrate behind these observations is unknown. The aim of this study was to obtain insight into the association between ageing, the host response and mortality in patients with COVID-19.Methods
We determined 43 biomarkers reflective of alterations in four pathophysiological domains: endothelial cell and coagulation activation, inflammation and organ damage, and cytokine and chemokine release. We used mediation analysis to associate ageing-driven alterations in the host response with 30-day mortality. Biomarkers associated with both ageing and mortality were validated in an intensive care unit and external cohort.Results
464 general ward patients with COVID-19 were stratified according to age decades. Increasing age was an independent risk factor for 30-day mortality. Ageing was associated with alterations in each of the host response domains, characterised by greater activation of the endothelium and coagulation system and stronger elevation of inflammation and organ damage markers, which was independent of an increase in age-related comorbidities. Soluble tumour necrosis factor receptor 1, soluble triggering receptor expressed on myeloid cells 1 and soluble thrombomodulin showed the strongest correlation with ageing and explained part of the ageing-driven increase in 30-day mortality (proportion mediated: 13.0%, 12.9% and 12.6%, respectively).Conclusions
Ageing is associated with a strong and broad modification of the host response to COVID-19, and specific immune changes likely contribute to increased mortality in older patients. These results may provide insight into potential age-specific immunomodulatory targets in COVID-19.
SUBMITTER: Michels EHA
PROVIDER: S-EPMC10151455 | biostudies-literature | 2023 Jul
REPOSITORIES: biostudies-literature
Michels Erik H A EHA Appelman Brent B de Brabander Justin J van Amstel Rombout B E RBE Chouchane Osoul O van Linge Christine C A CCA Schuurman Alex R AR Reijnders Tom D Y TDY Sulzer Titia A L TAL Klarenbeek Augustijn M AM Douma Renée A RA Bos Lieuwe D J LDJ Wiersinga W Joost WJ Peters-Sengers Hessel H van der Poll Tom T van Agtmael Michiel M Algera Anne Geke AG Appelman Brent B van Baarle Floor F Beudel Martijn M Bogaard Harm Jan HJ Bomers Marije M Bonta Peter P Bos Lieuwe L Botta Michela M de Brabander Justin J de Bree Godelieve G de Bruin Sanne S Bugiani Marianna M Bulle Esther E Buis David T P DTP Chouchane Osoul O Cloherty Alex A Dijkstra Mirjam M Dongelmans Dave A DA Dujardin Romein W G RWG Elbers Paul P Fleuren Lucas L Geerlings Suzanne S Geijtenbeek Theo T Girbes Armand A Goorhuis Bram B Grobusch Martin P MP Hagens Laura L Hamann Jorg J Harris Vanessa V Hemke Robert R Hermans Sabine M SM Heunks Leo L Hollmann Markus M Horn Janneke J Hovius Joppe W JW de Jong Hanna K HK de Jong Menno D MD Koning Rutger R Lemkes Bregje B Lim Endry H T EHT van Mourik Niels N Nellen Jeaninne J Nossent Esther J EJ Olie Sabine S Paulus Frederique F Peters Edgar E Pina-Fuentes Dan A I DAI van der Poll Tom T Preckel Bennedikt B Prins Jan M JM Raasveld Jorinde J Reijnders Tom T de Rotte Maurits C F J MCFJ Schinkel Michiel M Schultz Marcus J MJ Schrauwen Femke A P FAP Schuurman Alex A Schuurmans Jaap J Sigaloff Kim K Slim Marleen A MA Smeele Patrick P Smit Marry M Stijnis Cornelis S CS Stilma Willemke W Teunissen Charlotte C Thoral Patrick P Tsonas Anissa M AM Tuinman Pieter R PR van der Valk Marc M Veelo Denise P DP Volleman Carolien C de Vries Heder H Vught Lonneke A LA van Vugt Michèle M Wouters Dorien D Zwinderman A H Koos AHK Brouwer Matthijs C MC Wiersinga W Joost WJ Vlaar Alexander P J APJ van de Beek Diederik D
The European respiratory journal 20230707 1
<h4>Background</h4>Coronavirus disease 2019 (COVID-19)-induced mortality occurs predominantly in older patients. Several immunomodulating therapies seem less beneficial in these patients. The biological substrate behind these observations is unknown. The aim of this study was to obtain insight into the association between ageing, the host response and mortality in patients with COVID-19.<h4>Methods</h4>We determined 43 biomarkers reflective of alterations in four pathophysiological domains: endo ...[more]