Characterisation of the pro-inflammatory cytokine signature in severe COVID-19

Clinical outcomes from infection with SARS-CoV-2, the cause of the COVID-19 pandemic, are remarkably variable ranging from asymptomatic infection to severe pneumonia and death. One of the key drivers of this variability is differing trajectories in the immune response to SARS-CoV-2 infection. Many studies have noted markedly elevated cytokine levels in severe COVID-19, although results vary by cohort, cytokine studied and sensitivity of assay used. We assessed the immune response in acute COVID-19 by measuring 20 inflammatory markers in 118 unvaccinated patients with acute COVID-19 (median age: 70, IQR: 58-79 years; 48.3% female) recruited during the first year of the pandemic and 44 SARS-CoV-2 naïve healthy controls. Acute COVID-19 was associated with marked elevations in nearly all pro-inflammatory markers, whilst eleven markers (namely IL-1β, IL-2, IL-6, IL-10, IL-18, IL-23, IL-33, TNF-α, IP-10, G-CSF and YKL-40) were associated with disease severity. We observed significant correlations between nearly all markers elevated in those infected with SARS-CoV-2 consistent with widespread immune dysregulation. Principal component analysis highlighted a pro-inflammatory cytokine signature (with strongest contributions from IL-1β, IL-2, IL-6, IL-10, IL-33, G-CSF, TNF-α and IP-10) which was independently associated with severe COVID-19 (aOR: 1.40, 1.11-1.76, p=0.005), invasive mechanical ventilation (aOR: 1.61, 1.19-2.20, p=0.001) and mortality (aOR 1.57, 1.06-2.32, p = 0.02). Our findings demonstrate elevated cytokines and widespread immune dysregulation in severe COVID-19, adding further evidence for the role of a pro-inflammatory cytokine signature in severe and critical COVID-19.

An examination of the prevalence of metabolic syndrome in older adults in Ireland: Findings from The Irish Longitudinal Study on Ageing (TILDA)

Metabolic syndrome (MetS) consists of the cluster of central obesity, insulin resistance, hypertension and atherogenic dyslipidaemia. It is a risk factor for cardiovascular disease, diabetes, and mortality. The prevalence of MetS has not been described in older adults from a population-representative sample in a European country before. This study aimed to determine the prevalence of MetS in older adults in Ireland and examine the association between MetS and socio-demographic, health, and lifestyle factors. This study used data from a population aged ≥50 years from waves 1 and 3 of the Irish Longitudinal Study on Ageing. The prevalence of MetS using the National Cholesterol Education Program Third Adult Treatment Panel (ATPIII) and the International Diabetes Foundation (IDF) criteria were determined. Weighted logistic regression examined the association between MetS and age, sex, education, and physical activity. MetS status was determined at both waves with transitions examined. 5340 participants had complete data for MetS criteria at wave 1. 33% had MetS according to the ATPIII criteria (32.5%; 95% CI: 31.1, 34.0), with 39% according to the IDF criteria (39.3%; 95% CI: 37.8, 40.8). MetS was more prevalent with advancing age, among males, those with lower educational attainment and lower physical activity. 3609 participants had complete data for both waves– 25% of those with MetS at wave 1 did not have MetS at wave 3 but the overall number of participants with MetS increased by 19.8% (ATPIII) and 14.7% (IDF). MetS is highly prevalent in older adults in Ireland. 40% of the 1.2 million population aged ≥50 years in Ireland meet either the ATPIII or IDF criteria. Increasing age, male sex, lower educational attainment, and lower physical activity were all associated with an increased likelihood of MetS.

Biomarker Signatures of Two Phenotypical Prefrailty Types in the Irish Longitudinal Study on Ageing

We investigated the biomarker signatures of two previously reported phenotypical prefrailty (PF) types in the first wave of The Irish Longitudinal Study on Ageing (TILDA): PF1 (unexplained weight loss and/or exhaustion) and PF2 (one or two among slowness, weakness, and low physical activity). Binary logistic regression models evaluated the independent associations between available plasma biomarkers and each PF type (compared to robust and compared to each other), while adjusting for age, sex, and education. A total of 5307 participants were included (median age 61 years, 53% women) of which 1473 (28%) were prefrail (469 PF1; 1004 PF2), 171 were frail, and 3663 were robust. The PF2 median age was eight years older than the PF1 median age. Higher levels of lutein and zeaxanthin were independently associated with the lower likelihood of PF1 (OR: 0.77, p < 0.001 and OR: 0.81, p < 0.001, respectively). Higher cystatin C was associated with PF1 (OR: 1.23, p = 0.001). CRP (OR: 1.19, p < 0.001), cystatin C (OR: 1.36, p < 0.001), and HbA1c (OR: 1.18, p < 0.001) were independently associated with PF2, while a higher total (OR: 0.89, p = 0.004) and HDL (OR: 0.87, p < 0.001) cholesterol seemed to be PF2-protective. While PF1 seemed to be inversely associated with serum carotenoid concentrations and hence has an oxidative signature, PF2 seemed to have pro-inflammatory, hyperglycemic, and hypolipidemic signatures. Both PF types were associated with higher cystatin C (lower kidney function), but no biomarkers significantly distinguished PF1 vs. PF2. Further research should elucidate whether therapies for different PF types may require targeting of different biological pathways.

Atrial fibrillation and acceleration of frailty: findings from the Irish Longitudinal Study on Ageing

INTRODUCTION

both atrial fibrillation (AF) and frailty are increasingly prevalent with age. Cross-sectional studies have suggested a relationship between AF and frailty, but longitudinal data are lacking. We explored if the presence of AF was associated with accelerated progression of frailty over 8 years in community-dwelling older adults.

METHODS

a longitudinal retrospective case-control study was conducted using data from Waves 1 and 5 of the Irish Longitudinal Study on Ageing (TILDA). Participants with electrocardiographically detected AF at Wave 1 were matched to controls without AF (1:2) based on age and gender. Frailty was assessed using both the frailty phenotype (FP) and a 31-item frailty index (FI). Change in cases' and controls' FP and FI scores from Waves 1 to 5 were modelled using repeated measures analysis of variance (RM-ANOVA).

RESULTS

one hundred eighteen TILDA participants with AF at Wave 1 were matched to 236 controls. By FP, participants with AF were not significantly more frail than controls at Wave 1 (P = 0.166) but were at Wave 5 (P = 0.011), and RM-ANOVA suggested that frailty progressed more in participants with AF between Waves 1 and 5 compared with controls (P = 0.033). By FI, participants with AF were significantly more frail at Wave 1 (P < 0.001) and 5 (P = 0.010), and RM-ANOVA did not show a difference in frailty progression between groups (P = 0.955).

CONCLUSION

AF may drive the development of the FP. The FP is a pre-disability syndrome and hence may be better than the FI as a focus for disability prevention in adults with AF.

Study protocol for TILDA COVID-19 survey. Altered lives in a time of crisis: preparing for recovery from the impact of the COVID-19 pandemic on the lives of older adults

Background: Older adults are the most at-risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and among the most affected by measures put in place to prevent the spread of the virus. While the full effect of the public health measures, such as social distancing and wearing masks in public spaces, implemented since March 2020 are not yet known, it is expected that they will have a severely damaging effect on physical and psychological wellbeing. The Irish Longitudinal Study on Ageing (TILDA) has been researching the lives of older adults in Ireland since 2008 with data collection conducted at two-year intervals. With an established research infrastructure, TILDA was ideally placed to examine the effect of the coronavirus disease 2019 (COVID-19) pandemic on older adults. The aim of this study is to document the lives of older adults during the COVID-19 pandemic to understand the effect of the pandemic and public health responses on their wellbeing. Methods: Data was collected from TILDA participants via self-completion-questionnaire (SCQ). The SCQ contains ten sections that capture information on many aspects of people’s lives during the pandemic including, changes in behaviour and social interactions, physical and psychological wellbeing indicators, healthcare utilisation, and exposure to SARS-CoV-2. Ethical approval was granted by the National Research Ethics Committee (NREC). Conclusions: Research findings will be shared in a variety of formats including research reports and briefs, presentations, and academic papers. Data will be archived in the Irish Social Science Data Archive (ISSDA) and the Inter-university Consortium for Political and Social Research (ICPSR). As well as documenting the impact of the COVID-19 pandemic on older adults, findings from this study will provide important information to policy-makers as we respond to the damage caused by the COVID-19 pandemic.

Is phenotypical prefrailty all the same? A longitudinal investigation of two prefrailty subtypes in TILDA

BACKGROUND

Fried's frailty phenotype is defined by five criteria: exhaustion, unexplained weight loss, weakness, slowness and low physical activity. Prefrailty (PF) meets one or two criteria. PF is of interest as a target for preventative interventions, but it is not known if it is a homogenous syndrome.

OBJECTIVE

to compare the longitudinal trajectories of two PF groups: one defined by exhaustion and/or unexplained weight loss (PF1) and one defined by one or two of the following: weakness, slowness, low physical activity (PF2).

DESIGN AND SETTING

population-based longitudinal study of ageing.

SUBJECTS

One-thousand four-hundred seventy-six PF participants aged ≥50 years from wave 1 of the study (2010), followed 2-yearly over four longitudinal waves (2012, 2014, 2016, 2018).

METHODS

generalised estimating equations (GEEs) were used to assess the effect of PF type across waves to predict cumulative mortality and disability in basic activities of daily living (ADL) and independent ADL (IADL), adjusting for baseline characteristics (age, sex, education, living alone, self-rated health, comorbidity, body mass index).

RESULTS

in wave 1, there were 503 PF1 and 973 PF2 participants. By wave 5, 38 (7.6%) PF1 and 145 (14.9%) PF2 participants had died. In PF1 participants, mean numbers of ADL and IADL disabilities both increased from 0.1 to 0.2 from wave 1 to wave 5, whilst in PF2 increases were from 0.2 to 0.5. Adjusted GEE models suggested significantly divergent trajectories of IADL disability by wave 2, ADL disability by wave 3 and mortality by wave 3.

CONCLUSION

PF may not be a homogenous biological syndrome.

Prevalence of age-related macular degeneration associated genetic risk factors and 4-year progression data in the Irish population

Background/aims

Age-related macular degeneration (AMD) is estimated to affect 196 million people >50 years old globally. Prevalence of AMD-associated genetic risk factors and rate of disease progression are unknown in Ireland.

Methods

Prevalence of AMD-associated genetic risk variants, complement factor H (CFH) rs1061170, age-related maculopathy susceptibility 2 (ARMS2) rs10490924, component 3 (C3) rs2230199, complement factor B (CFB) rs641153 and superkiller viralicidic activity 2-like (SKIV2L) rs429608 and 4-year progression data in a population-representative cohort (The Irish Longitudinal study on Ageing (TILDA)) were assessed. 4473 participants ≥50 years were assessed. 4173 had no disease n=1843; 44% male and n=2330; 56% female, mean age 60±9.0, 300 had AMD n=136; 45% male and n=164; 55% female, mean age 64±9.0. A 4-year follow-up was undertaken with 66% of AMD cases attending. Progression and regression from early to late AMD were measured. Genetic association as indicators of disease and as predictors of progression were assessed by multinomial logistic regression.

Results

Older age and the presence of CFH and ARMS2 risk alleles are two main risk factors associated with the prevalence of AMD in the TILDA cohort. 23% progressed to a higher grade of AMD. Carriers of CFH risk allele showed a strong association for disease progression. Heterozygosity for ARMS2 risk allele predicted progression to late AMD. 75% of those who progressed from early to late disease had soft drusen and hyperpigmentation at baseline.

Conclusions

The prevalence of risk-associated genes and 4-year progression rates of AMD in this Ireland cohort are comparable with other Caucasian populations. CFH Y402H is associated with disease progression, with soft drusen and hyperpigmentation as high-risk features.