Post-COVID-19 illness and associations with sex and gender

Abstract

Background Post-COVID-19 syndromes have associated with female sex, but the pathophysiological basis is uncertain. Aim There are sex differences in myocardial inflammation identified using cardiac magnetic resonance (CMR) in post-COVID-19 patients, and in patient reported health outcomes following COVID-19 infection. Design This prospective study investigated the time-course of multiorgan injury in survivors of COVID-19 during convalescence. Methods Clinical information, blood biomarkers, and patient reported outcome measures were prospectively acquired at enrolment (visit 1) and 28–60 days post-discharge (visit 2). Chest computed tomography (CT) and CMR were performed at visit 2. Follow-up was carried out for serious adverse events, including death and rehospitalization. Results Sixty-nine (43%) of 159 patients recruited were female. During the index admission, females had a lower peak C-reactive protein (74 mg/l (21,163) versus 123 mg/l (70, 192) p = 0.008) and peak ferritin (229 μg/l (103, 551) versus 514 μg/l (228, 1122) p < 0.001). Using the Modified Lake-Louise criteria, females were more likely to have definite evidence of myocardial inflammation (54% (37/68) versus 33% (30/90) p = 0.003). At enrolment and 28–60 days post-discharge, enhanced illness perception, higher levels of anxiety and depression and lower predicted maximal oxygen utilization occurred more commonly in women. The mean (SD, range) duration of follow-up after hospital discharge was 450 (88) days (range 290, 627 days). Compared to men, women had lower rates of cardiovascular hospitalization (0% versus 8% (7/90); p = 0.018). Conclusions Women demonstrated worse patient reported outcome measures at index admission and 28–60 days follow-up though cardiovascular hospitalization was lower.

Establishment and characterization of an hACE2/hTMPRSS2 knock-in mouse model to study SARS-CoV-2

“…With uCT and the other cardiovascular metrics used here, we observed that SARS-CoV-2 infection produced visual changes in uCT intensity but no quantitative changes in total lung capacity or other measures of lung function or markers of cardiovascular function in the ensuing 6 months or after a second virus inoculation administered 6 months after the first inoculation. Our observations of reduced ambulation in male but not female mice mirror post-COVID-19 outcomes in people where females experience lower rates of cardiovascular-related hospitalizations after COVID-19 ( 37 ). When subjected to a six minute walking exercise followed by pulmonary function tests, males humans also experience higher post-stress respiratory outcomes compared to females ( 38 ).…”

Neurocognitive Changes in Patients with Post-COVID Depression

“…From the point of view of gender differences during COVID-19 and its complications, there is a fundamental contradiction unexplained to date. In particular, men are more likely than women to experience a more severe course of COVID-19 [ 75 , 76 , 77 ], but women are more likely to experience post-COVID complications [ 16 , 22 , 25 , 62 , 64 , 77 , 78 ]. Some studies have suggested that male sex is a predictor of more severe cognitive impairment in post-COVID-19 [ 79 ].…”

“…The increased risk of post-COVID complications in women during menopause [ 80 ] and gender differences in autoimmune response [ 75 , 81 ] are mainly discussed. A more severe acute phase of COVID-19 in men is mainly associated with a worse immune-inflammatory response [ 76 , 82 ], a lack of protective effect of sex hormones [ 81 ], and angiotensin-converting enzyme 2 (ACE2) receptor [ 75 ].…”

The Prevalence and Associated Factors of Post-COVID-19 Fatigue: A Systematic Review and Meta-Analysis

“…For types of evaluation tools, several standardized tools were used for assessing fatigue symptoms, and some studies developed fatigue symptom checklists or questionnaires by themselves. One study validated the use of the Fatigue Severity Scale (FSS) and two single-item screening questions in two groups, and it was reported that the FSS showed a higher internal consistency and construct validity [ 70 ]. However, there is no standardized assessment tool or scale for assessing post-COVID-19 fatigue.…”