TY - JOUR
T1 - Individual factors including age, BMI and heritable factors underlie temperature variation in sickness and in health
T2 - an observational, multi-cohort study
AU - GSTT CovidCollaborative
AU - Penfold, Rose S
AU - Zazzara, Maria Beatrice
AU - Österdahl, Marc F
AU - Welch, Carly
AU - Ni Lochlainn, Mary
AU - Freidin, Maxim B
AU - Bowyer, Ruth C E
AU - Thompson, Ellen
AU - Antonelli, Michela
AU - Tan, Yu Xian Rachel
AU - Sudre, Carole H
AU - Modat, Marc
AU - Murray, Benjamin
AU - Wolf, Jonathan
AU - Ourselin, Sebastien
AU - Veenith, Tonny
AU - Lord, Janet M
AU - Steves, Claire J
N1 - © The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: [email protected].
PY - 2021/10/5
Y1 - 2021/10/5
N2 - BACKGROUND: Ageing affects immunity, potentially altering fever response to infection. We assess effects of biological variables on basal temperature, and during COVID-19 infection, proposing an updated temperature threshold for older adults ≥65 years.METHODS: Participants were from four cohorts: 1089 unaffected adult TwinsUK volunteers; 520 adults with emergency admission to a London hospital with RT-PCR confirmed SARS-CoV-2 infection; 757 adults with emergency admission to a Birmingham hospital with RT-PCR confirmed SARS-CoV-2 infection and 3972 adult community-based COVID Symptom Study participants self-reporting a positive RT-PCR test. Heritability was assessed using saturated and univariate ACE models; mixed-effect and multivariable linear regression examined associations between temperature, age, sex and BMI; multivariable logistic regression examined associations between fever (≥37.8°C) and age; receiver operating characteristic (ROC) analysis was used to identify temperature threshold for adults ≥ 65 years.RESULTS: Among unaffected volunteers, lower BMI (p=0.001), and increasing age (p<0.001) associated with lower basal temperature. Basal temperature showed a heritability of 47% 95% Confidence Interval 18-57%). In COVID-19+ participants, increasing age was associated with lower temperatures in Birmingham and community-based cohorts (p<0.001). For each additional year of age, participants were 1% less likely to demonstrate a fever ≥37.8°C (OR 0.99; p<0.001). Combining healthy and COVID-19+ participants, a temperature of 37.4°C in adults ≥65 years had similar sensitivity and specificity to 37.8°C in adults <65 years for discriminating infection.CONCLUSIONS: Ageing affects temperature in health and acute infection, with significant heritability, indicating genetic factors contribute to temperature regulation. Our observations suggest a lower threshold (37.4°C/97.3°F) for identifying fever in older adults ≥65 years.
AB - BACKGROUND: Ageing affects immunity, potentially altering fever response to infection. We assess effects of biological variables on basal temperature, and during COVID-19 infection, proposing an updated temperature threshold for older adults ≥65 years.METHODS: Participants were from four cohorts: 1089 unaffected adult TwinsUK volunteers; 520 adults with emergency admission to a London hospital with RT-PCR confirmed SARS-CoV-2 infection; 757 adults with emergency admission to a Birmingham hospital with RT-PCR confirmed SARS-CoV-2 infection and 3972 adult community-based COVID Symptom Study participants self-reporting a positive RT-PCR test. Heritability was assessed using saturated and univariate ACE models; mixed-effect and multivariable linear regression examined associations between temperature, age, sex and BMI; multivariable logistic regression examined associations between fever (≥37.8°C) and age; receiver operating characteristic (ROC) analysis was used to identify temperature threshold for adults ≥ 65 years.RESULTS: Among unaffected volunteers, lower BMI (p=0.001), and increasing age (p<0.001) associated with lower basal temperature. Basal temperature showed a heritability of 47% 95% Confidence Interval 18-57%). In COVID-19+ participants, increasing age was associated with lower temperatures in Birmingham and community-based cohorts (p<0.001). For each additional year of age, participants were 1% less likely to demonstrate a fever ≥37.8°C (OR 0.99; p<0.001). Combining healthy and COVID-19+ participants, a temperature of 37.4°C in adults ≥65 years had similar sensitivity and specificity to 37.8°C in adults <65 years for discriminating infection.CONCLUSIONS: Ageing affects temperature in health and acute infection, with significant heritability, indicating genetic factors contribute to temperature regulation. Our observations suggest a lower threshold (37.4°C/97.3°F) for identifying fever in older adults ≥65 years.
KW - COVID-19
KW - Fever
KW - Immunesenescence
KW - Infection
KW - Thermoregulation
UR - https://www.scopus.com/pages/publications/85137138652
U2 - 10.1093/gerona/glab295
DO - 10.1093/gerona/glab295
M3 - Article
C2 - 34609487
SN - 1079-5006
JO - The journals of gerontology. Series A, Biological sciences and medical sciences
JF - The journals of gerontology. Series A, Biological sciences and medical sciences
M1 - glab295
ER -