Background Aging 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 4 cohorts: 1 089 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 3 972 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 body mass index (BMI); multivariable logistic regression examined associations between fever (>= 37.8 degrees 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 = .001), and increasing age (p < .001) was 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 < .001). For each additional year of age, participants were 1% less likely to demonstrate a fever >= 37.8 degrees C (OR 0.99; p < .001). Combining healthy and COVID-19+ participants, a temperature of 37.4 degrees C in adults >= 65 years had similar sensitivity and specificity to 37.8 degrees C in adults Conclusions Aging 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 degrees C/97.3 degrees F) for identifying fever in older adults >= 65 years.
Penfold, R. S., Zazzara, M. B., Österdahl, M. F., Welch, C., Lochlainn, M. N., Freidin, M. B., Bowyer, R. C. E., Thompson, E., Antonelli, M., Tan, Y. X. R., Sudre, C. H., Modat, M., Murray, B., Wolf, J., Ourselin, S., Veenith, T., Lord, J. M., Steves, C. J., Individual Factors Including Age, BMI, and Heritable Factors Underlie Temperature Variation in Sickness and in Health: An Observational, Multi-cohort Study, <<JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES>>, 2022; 77 (9): 1890-1897. [doi:10.1093/gerona/glab295] [https://hdl.handle.net/10807/340818]
Individual Factors Including Age, BMI, and Heritable Factors Underlie Temperature Variation in Sickness and in Health: An Observational, Multi-cohort Study
Zazzara, Maria BeatriceCo-primo
;
2022
Abstract
Background Aging 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 4 cohorts: 1 089 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 3 972 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 body mass index (BMI); multivariable logistic regression examined associations between fever (>= 37.8 degrees 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 = .001), and increasing age (p < .001) was 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 < .001). For each additional year of age, participants were 1% less likely to demonstrate a fever >= 37.8 degrees C (OR 0.99; p < .001). Combining healthy and COVID-19+ participants, a temperature of 37.4 degrees C in adults >= 65 years had similar sensitivity and specificity to 37.8 degrees C in adults Conclusions Aging 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 degrees C/97.3 degrees F) for identifying fever in older adults >= 65 years.
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