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Volume 13
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Telomere Length and COVID-19 Severity: A Comparative Cross-Sectional Study Across the Clinical Spectrum

by
Flora Bacopoulou
1,
Anastasios Tentolouris
2,
Eleni Koniari
3,
Dimitrios Kalogirou
4,
Dimitrios Basoulis
5,
Ioanna Eleftheriadou
2,
Pinelopi Grigoropoulou
6,
Vasiliki Efthymiou
3,
Konstantina K. Georgoulia
3,
Ioanna A. Anastasiou
2,
Stavroula Papadodima
7,*,
George Chrousos
3 and
Nikolaos Tentolouris
2
1
Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece
2
First Department of Propaedeutic Internal Medicine and Diabetes Center, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
3
University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair in Adolescent Health Care, National and Kapodistrian University of Athens, 11527 Athens, Greece
4
Department of Public and Community Health, School of Public Health, University of West Attica, 11521 Athens, Greece
5
Infectious Diseases Unit, Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens Laiko, 11527 Athens, Greece
6
Department of Internal Medicine, General Hospital of Athens “ELPIS”, 11522 Athens, Greece
7
Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
*
Author to whom correspondence should be addressed.
Healthcare 2025, 13(20), 2656; https://doi.org/10.3390/healthcare13202656
Submission received: 24 August 2025 / Revised: 13 October 2025 / Accepted: 15 October 2025 / Published: 21 October 2025
Versions Notes

Abstract

Background: Telomere attrition has been implicated in immune function and vulnerability to infectious diseases. However, the relation between telomere length and COVID-19 severity remains unclear. Methods: In this cross-sectional study, patients aged 30–75 years, with confirmed SARS-CoV-2 infection, as well as age- and BMI-matched controls without COVID-19, were recruited over a period of 1 year (2021–2022) from the outpatient clinics and wards of the General Hospitals “Laiko” and “Elpis” in Athens, Greece. Telomere length, expressed as a telomere to single-copy gene (T/S) ratio, was measured in all participants using a quantitative PCR-based method. Participants’ clinical, biochemical, demographic, and respiratory parameters were assessed in relation to their telomere length. Results: Study participants included a total of 139 individuals divided into three groups: controls (n = 34), patients with non-severe COVID-19 (n = 50), and patients with severe COVID-19 (n = 55). Patients with severe COVID-19 had significantly shorter telomeres when compared to both the non-severe COVID-19 group and controls (p < 0.001). Logistic regression analysis confirmed that telomere length was independently associated with disease severity (p < 0.001). Females demonstrated longer telomeres than males (p = 0.039), but no significant correlation was found between telomere length and age. When patients with non-severe and severe COVID-19 were analyzed together, no significant difference in telomere length was observed compared to controls (p = 0.727). Conclusions: Shortened telomeres may be linked to more severe forms of COVID-19, suggesting a potential role for telomere biology in disease progression. Results highlight the need for further research into telomere dynamics as a biomarker for disease susceptibility and outcome in viral infections.
Keywords: COVID-19; SARS-CoV-2; coronavirus; telomeres; telomere length; severity COVID-19; SARS-CoV-2; coronavirus; telomeres; telomere length; severity

Share and Cite

MDPI and ACS Style

Bacopoulou, F.; Tentolouris, A.; Koniari, E.; Kalogirou, D.; Basoulis, D.; Eleftheriadou, I.; Grigoropoulou, P.; Efthymiou, V.; Georgoulia, K.K.; Anastasiou, I.A.; et al. Telomere Length and COVID-19 Severity: A Comparative Cross-Sectional Study Across the Clinical Spectrum. Healthcare 2025, 13, 2656. https://doi.org/10.3390/healthcare13202656

AMA Style

Bacopoulou F, Tentolouris A, Koniari E, Kalogirou D, Basoulis D, Eleftheriadou I, Grigoropoulou P, Efthymiou V, Georgoulia KK, Anastasiou IA, et al. Telomere Length and COVID-19 Severity: A Comparative Cross-Sectional Study Across the Clinical Spectrum. Healthcare. 2025; 13(20):2656. https://doi.org/10.3390/healthcare13202656

Chicago/Turabian Style

Bacopoulou, Flora, Anastasios Tentolouris, Eleni Koniari, Dimitrios Kalogirou, Dimitrios Basoulis, Ioanna Eleftheriadou, Pinelopi Grigoropoulou, Vasiliki Efthymiou, Konstantina K. Georgoulia, Ioanna A. Anastasiou, and et al. 2025. "Telomere Length and COVID-19 Severity: A Comparative Cross-Sectional Study Across the Clinical Spectrum" Healthcare 13, no. 20: 2656. https://doi.org/10.3390/healthcare13202656

APA Style

Bacopoulou, F., Tentolouris, A., Koniari, E., Kalogirou, D., Basoulis, D., Eleftheriadou, I., Grigoropoulou, P., Efthymiou, V., Georgoulia, K. K., Anastasiou, I. A., Papadodima, S., Chrousos, G., & Tentolouris, N. (2025). Telomere Length and COVID-19 Severity: A Comparative Cross-Sectional Study Across the Clinical Spectrum. Healthcare, 13(20), 2656. https://doi.org/10.3390/healthcare13202656

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