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Aging (Albany NY) ; 12(13): 12504-12516, 2020 07 11.
Article in English | MEDLINE | ID: covidwho-640201


The mortality rate of elderly patients with Coronavirus Disease 2019 (COVID-19) was significantly higher than the overall mortality rate. However, besides age, leading death risk factors for the high mortality in elderly patients remain unidentified. This retrospective study included 210 elderly COVID-19 patients (aged ≥ 65 years), of whom 175 patients were discharged and 35 died. All deceased patients had at least one comorbidity. A significantly higher proportion of patients in the deceased group had cardiovascular diseases (49% vs. 20%), respiratory diseases (51% vs. 11%), chronic kidney disease (29% vs. 5%) and cerebrovascular disease (20% vs. 3%) than that in the discharged group. The median levels of C-reactive protein (125.8mg/L vs. 9.3mg/L) and blood urea nitrogen (7.2mmol/L vs. 4.4mmol/L) were significantly higher and median lymphocyte counts (0.7×109/L vs. 1.1×109/L) significantly lower in the deceased group than those in the discharged group. The survival curve analysis showed that higher C-reactive protein (≥5mg/L) plus any other abnormalities of lymphocyte, blood urea nitrogen or lactate dehydrogenase significantly predicted poor prognosis of COVID-19 infected elderly patients. This study revealed that the risk factors for the death in these elderly patients included comorbidities, increased levels of C-reactive protein and blood urea nitrogen, and lymphopenia during hospitalization.

Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Aged , Aged, 80 and over , Betacoronavirus , Blood Urea Nitrogen , C-Reactive Protein/metabolism , COVID-19 , China , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/immunology , Female , Humans , Lymphopenia/virology , Male , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/immunology , Prognosis , Retrospective Studies , Risk Factors , SARS-CoV-2
JCI Insight ; 5(14)2020 07 23.
Article in English | MEDLINE | ID: covidwho-607189


BACKGROUNDReprogramming of host metabolism supports viral pathogenesis by fueling viral proliferation, by providing, for example, free amino acids and fatty acids as building blocks.METHODSTo investigate metabolic effects of SARS-CoV-2 infection, we evaluated serum metabolites of patients with COVID-19 (n = 33; diagnosed by nucleic acid testing), as compared with COVID-19-negative controls (n = 16).RESULTSTargeted and untargeted metabolomics analyses identified altered tryptophan metabolism into the kynurenine pathway, which regulates inflammation and immunity. Indeed, these changes in tryptophan metabolism correlated with interleukin-6 (IL-6) levels. Widespread dysregulation of nitrogen metabolism was also seen in infected patients, with altered levels of most amino acids, along with increased markers of oxidant stress (e.g., methionine sulfoxide, cystine), proteolysis, and renal dysfunction (e.g., creatine, creatinine, polyamines). Increased circulating levels of glucose and free fatty acids were also observed, consistent with altered carbon homeostasis. Interestingly, metabolite levels in these pathways correlated with clinical laboratory markers of inflammation (i.e., IL-6 and C-reactive protein) and renal function (i.e., blood urea nitrogen).CONCLUSIONIn conclusion, this initial observational study identified amino acid and fatty acid metabolism as correlates of COVID-19, providing mechanistic insights, potential markers of clinical severity, and potential therapeutic targets.FUNDINGBoettcher Foundation Webb-Waring Biomedical Research Award; National Institute of General and Medical Sciences, NIH; and National Heart, Lung, and Blood Institute, NIH.

Coronavirus Infections/metabolism , Fatty Acids/metabolism , Interleukin-6/metabolism , Kynurenine/metabolism , Oxidative Stress , Pneumonia, Viral/metabolism , Renal Insufficiency/metabolism , Adult , Aged , Amino Acids/metabolism , Betacoronavirus , Blood Glucose/metabolism , COVID-19 , Case-Control Studies , Creatine/metabolism , Creatinine/metabolism , Cystine , Fatty Acids, Nonesterified/metabolism , Female , Humans , Male , Metabolome , Metabolomics , Methionine/analogs & derivatives , Middle Aged , Pandemics , Polyamines/metabolism , Proteolysis , SARS-CoV-2 , Tryptophan/metabolism