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Penfold RS, Zazzara MB, Österdahl MF. Individual factors including age, BMI and heritable factors underlie temperature variation in sickness and in health: an observational, multi-cohort study. J Gerontol A Biol Sci Med Sci. 2021;doi: 10.1093/gerona/glab295.
Penfold, R. S., Zazzara, M. B., Österdahl, M. F., Welch, C., Ni Lochlainn, M., 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. (2021). Individual factors including age, BMI and heritable factors underlie temperature variation in sickness and in health: an observational, multi-cohort study. The journals of gerontology. Series A, Biological sciences and medical sciences, . https://doi.org/10.1093/gerona/glab295
Penfold, Rose S, et al. "Individual factors including age, BMI and heritable factors underlie temperature variation in sickness and in health: an observational, multi-cohort study." The journals of gerontology. Series A, Biological sciences and medical sciences vol. (2021). doi: https://doi.org/10.1093/gerona/glab295
Penfold RS, Zazzara MB, Österdahl MF, Welch C, Ni Lochlainn M, Freidin MB, Bowyer RCE, Thompson E, Antonelli M, Tan YXR, Sudre CH, Modat M, Murray B, Wolf J, Ourselin S, Veenith T, Lord JM, Steves CJ. Individual factors including age, BMI and heritable factors underlie temperature variation in sickness and in health: an observational, multi-cohort study. J Gerontol A Biol Sci Med Sci. 2021 Oct 05; doi: 10.1093/gerona/glab295. Epub 2021 Oct 05. PMID: 34609487; PMCID: PMC8513412.
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J Gerontol A Biol Sci Med Sci. 2021 Oct 05; doi: 10.1093/gerona/glab295. Epub 2021 Oct 05.

Individual factors including age, BMI and heritable factors underlie temperature variation in sickness and in health: an observational, multi-cohort study.

The journals of gerontology. Series A, Biological sciences and medical sciences

Rose S Penfold, Maria Beatrice Zazzara, Marc F Österdahl, Carly Welch, Mary Ni Lochlainn, Maxim B Freidin, Ruth C E Bowyer, Ellen Thompson, Michela Antonelli, Yu Xian Rachel Tan, Carole H Sudre, Marc Modat, Benjamin Murray, Jonathan Wolf, Sebastien Ourselin, Tonny Veenith, Janet M Lord, Claire J Steves

Affiliations

  1. Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London.
  2. Guy's and St Thomas' NHS Foundation Trust.
  3. Department of Gerontology, Neuroscience and Orthopedics, Sacred Heart Catholic University, Rome, Italy.
  4. Institute of Inflammation and Ageing, University of Birmingham, B15 2TT, Birmingham, UK.
  5. School of Biomedical Engineering and Imaging Sciences, King's College London, SE17EH, London, UK.
  6. Department of Medicine, Royal College of Surgeons in Ireland, 123 St Stephen Green, Dublin 2, Ireland.
  7. Zoe Global Limited, London SE1 7RW, UK.

PMID: 34609487 PMCID: PMC8513412 DOI: 10.1093/gerona/glab295

Abstract

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.

© 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].

Keywords: COVID-19; fever; immunesenescence; infection; thermoregulation

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