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Delfino C, Poli MC, Vial C, Vial PA, Martínez G, Riviotta A, Arbat C, Mac-Guire N, Hoppe J, Carvajal C, Muñoz Venturelli P. Post-COVID-19 condition: a sex-based analysis of clinical and laboratory trends. Front Med (Lausanne) 2024; 11:1376030. [PMID: 38919940 PMCID: PMC11198115 DOI: 10.3389/fmed.2024.1376030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/15/2024] [Indexed: 06/27/2024] Open
Abstract
Background and aim Post-COVID-19 condition (PCC) encompasses long-lasting symptoms in individuals with COVID-19 and is estimated to affect between 31-67% of patients, with women being more commonly affected. No definitive biomarkers have emerged in the acute stage that can help predict the onset of PCC, therefore we aimed at describing sex-disaggregated data of PCC patients from a local cohort and explore potential acute predictors of PCC and neurologic PCC. Methods A local cohort of consecutive patients admitted with COVID-19 diagnosis between June 2020 and July 2021 were registered, and clinical and laboratory data were recorded. Only those <65 years, discharged alive and followed up at 6 and 12 months after admission were considered in these analyses. Multivariable logistic regression analysis was performed to explore variables associated with PCC (STATA v 18.0). Results From 130 patients in the cohort, 104 were contacted: 30% were women, median age of 42 years. At 6 months, 71 (68%) reported PCC symptoms. Women exhibited a higher prevalence of any PCC symptom (87 vs. 60%, p = 0.007), lower ferritin (p = 0.001) and procalcitonin (p = 0.021) and higher TNF levels (p = 0.042) in the acute phase compared to men. Being women was independently associated to 7.60 (95% CI 1.27-45.18, p = 0.026) higher risk for PCC. Moreover, women had lower return to normal activities 6 and 12 months. Conclusion Our findings highlight the lasting impact of COVID-19, particularly in young women, emphasising the need for tailored post-COVID care. The lower ferritin levels in women are an intriguing observation, warranting further research. The study argues for comprehensive strategies that address sex-specific challenges in recovery from COVID-19.
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Affiliation(s)
- Carlos Delfino
- Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - M. Cecilia Poli
- Facultad de Medicina Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
- Programa de Inmunogenética e Inmunología Traslacional, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Santiago, Chile
- Unidad de Inmunología y Reumatología, Hospital Roberto del Río, Santiago, Chile
| | - Cecilia Vial
- Facultad de Medicina Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
- Programa de Hantavirus y Zoonosis, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Santiago, Chile
| | - Pablo A. Vial
- Facultad de Medicina Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
- Programa de Hantavirus y Zoonosis, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Santiago, Chile
| | - Gonzalo Martínez
- Departamento de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Amy Riviotta
- Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Catalina Arbat
- Facultad de Medicina Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Nicole Mac-Guire
- Facultad de Medicina Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Josefina Hoppe
- Facultad de Medicina Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Cristóbal Carvajal
- Centro de Informática Biomédica, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana—Universidad del Desarrollo, Santiago, Chile
| | - Paula Muñoz Venturelli
- Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana—Universidad del Desarrollo, Santiago, Chile
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Phetsouphanh C, Jacka B, Ballouz S, Jackson KJL, Wilson DB, Manandhar B, Klemm V, Tan HX, Wheatley A, Aggarwal A, Akerman A, Milogiannakis V, Starr M, Cunningham P, Turville SG, Kent SJ, Byrne A, Brew BJ, Darley DR, Dore GJ, Kelleher AD, Matthews GV. Improvement of immune dysregulation in individuals with long COVID at 24-months following SARS-CoV-2 infection. Nat Commun 2024; 15:3315. [PMID: 38632311 PMCID: PMC11024141 DOI: 10.1038/s41467-024-47720-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
This study investigates the humoral and cellular immune responses and health-related quality of life measures in individuals with mild to moderate long COVID (LC) compared to age and gender matched recovered COVID-19 controls (MC) over 24 months. LC participants show elevated nucleocapsid IgG levels at 3 months, and higher neutralizing capacity up to 8 months post-infection. Increased spike-specific and nucleocapsid-specific CD4+ T cells, PD-1, and TIM-3 expression on CD4+ and CD8+ T cells were observed at 3 and 8 months, but these differences do not persist at 24 months. Some LC participants had detectable IFN-γ and IFN-β, that was attributed to reinfection and antigen re-exposure. Single-cell RNA sequencing at the 24 month timepoint shows similar immune cell proportions and reconstitution of naïve T and B cell subsets in LC and MC. No significant differences in exhaustion scores or antigen-specific T cell clones are observed. These findings suggest resolution of immune activation in LC and return to comparable immune responses between LC and MC over time. Improvement in self-reported health-related quality of life at 24 months was also evident in the majority of LC (62%). PTX3, CRP levels and platelet count are associated with improvements in health-related quality of life.
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Affiliation(s)
| | - Brendan Jacka
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Sara Ballouz
- Garvan Institute for Medical research, Sydney, NSW, Australia
- School of Computer Science and Engineering, Faculty of Engineering, University of New South Wales, Sydney, NSW, Australia
| | | | - Daniel B Wilson
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Bikash Manandhar
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Vera Klemm
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Hyon-Xhi Tan
- Department of Microbiology and Immunology, Peter Doherty Institute, University of Melbourne, Victoria, VIC, Australia
| | - Adam Wheatley
- Department of Microbiology and Immunology, Peter Doherty Institute, University of Melbourne, Victoria, VIC, Australia
| | - Anupriya Aggarwal
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Anouschka Akerman
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Mitchell Starr
- NSW State Reference Laboratory for HIV, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Phillip Cunningham
- NSW State Reference Laboratory for HIV, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | - Stuart G Turville
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Stephen J Kent
- Department of Microbiology and Immunology, Peter Doherty Institute, University of Melbourne, Victoria, VIC, Australia
| | - Anthony Byrne
- Heart Lung Clinic, St. Vincent's Hospital Sydney and Faculty of Medicine and Health (UNSW), Sydney, NSW, Australia
| | - Bruce J Brew
- Peter Duncan Neurosciences Unit- St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
| | | | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
- St. Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Anthony D Kelleher
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
- St. Vincent's Hospital, Darlinghurst, NSW, Australia.
| | - Gail V Matthews
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
- St. Vincent's Hospital, Darlinghurst, NSW, Australia.
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Domènech-Montoliu S, Puig-Barberà J, Pac-Sa MR, Orrico-Sanchéz A, Gómez-Lanas L, Sala-Trull D, Domènech-Leon C, Del Rio-González A, Sánchez-Urbano M, Satorres-Martinez P, Aparisi-Esteve L, Badenes-Marques G, Blasco-Gari R, Casanova-Suarez J, Gil-Fortuño M, Hernández-Pérez N, Jovani-Sales D, López-Diago L, Notari-Rodríguez C, Pérez-Olaso O, Romeu-Garcia MA, Ruíz-Puig R, Arnedo-Pena A. Cellular Immunity of SARS-CoV-2 in the Borriana COVID-19 Cohort: A Nested Case-Control Study. EPIDEMIOLOGIA 2024; 5:167-186. [PMID: 38651389 PMCID: PMC11036210 DOI: 10.3390/epidemiologia5020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/27/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024] Open
Abstract
Our goal was to determine the cellular immune response (CIR) in a sample of the Borriana COVID-19 cohort (Spain) to identify associated factors and their relationship with infection, reinfection and sequelae. We conducted a nested case-control study using a randomly selected sample of 225 individuals aged 18 and older, including 36 individuals naïve to the SARS-CoV-2 infection and 189 infected patients. We employed flow-cytometry-based immunoassays for intracellular cytokine staining, using Wuhan and BA.2 antigens, and chemiluminescence microparticle immunoassay to detect SARS-CoV-2 antibodies. Logistic regression models were applied. A total of 215 (95.6%) participants exhibited T-cell response (TCR) to at least one antigen. Positive responses of CD4+ and CD8+ T cells were 89.8% and 85.3%, respectively. No difference in CIR was found between naïve and infected patients. Patients who experienced sequelae exhibited a higher CIR than those without. A positive correlation was observed between TCR and anti-spike IgG levels. Factors positively associated with the TCR included blood group A, number of SARS-CoV-2 vaccine doses received, and anti-N IgM; factors inversely related were the time elapsed since the last vaccine dose or infection, and blood group B. These findings contribute valuable insights into the nuanced immune landscape shaped by SARS-CoV-2 infection and vaccination.
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Affiliation(s)
| | - Joan Puig-Barberà
- Vaccines Research Unit, Foundation for the Promotion of Health and Biomedical Research in Valencia Region FISABIO-Public Health, 46020 Valencia, Spain; (J.P.-B.); (A.O.-S.)
| | - María Rosario Pac-Sa
- Public Health Center, 12003 Castelló de la Plana, Spain; (M.R.P.-S.); (M.A.R.-G.)
| | - Alejandro Orrico-Sanchéz
- Vaccines Research Unit, Foundation for the Promotion of Health and Biomedical Research in Valencia Region FISABIO-Public Health, 46020 Valencia, Spain; (J.P.-B.); (A.O.-S.)
- Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Secretary of Chair of Vaccines Catholic University of Valencia, 46001 Valencia, Spain
| | - Lorna Gómez-Lanas
- Emergency Service University Hospital de la Plana, 12540 Vila-real, Spain; (L.G.-L.); (D.S.-T.); (M.S.-U.); (P.S.-M.); (G.B.-M.); (R.B.-G.); (D.J.-S.); (C.N.-R.); (R.R.-P.)
| | - Diego Sala-Trull
- Emergency Service University Hospital de la Plana, 12540 Vila-real, Spain; (L.G.-L.); (D.S.-T.); (M.S.-U.); (P.S.-M.); (G.B.-M.); (R.B.-G.); (D.J.-S.); (C.N.-R.); (R.R.-P.)
| | - Carmen Domènech-Leon
- Department of Medicine, University CEU Cardenal Herrera, 12006 Castelló de la Plana, Spain;
| | | | - Manuel Sánchez-Urbano
- Emergency Service University Hospital de la Plana, 12540 Vila-real, Spain; (L.G.-L.); (D.S.-T.); (M.S.-U.); (P.S.-M.); (G.B.-M.); (R.B.-G.); (D.J.-S.); (C.N.-R.); (R.R.-P.)
| | - Paloma Satorres-Martinez
- Emergency Service University Hospital de la Plana, 12540 Vila-real, Spain; (L.G.-L.); (D.S.-T.); (M.S.-U.); (P.S.-M.); (G.B.-M.); (R.B.-G.); (D.J.-S.); (C.N.-R.); (R.R.-P.)
| | | | - Gema Badenes-Marques
- Emergency Service University Hospital de la Plana, 12540 Vila-real, Spain; (L.G.-L.); (D.S.-T.); (M.S.-U.); (P.S.-M.); (G.B.-M.); (R.B.-G.); (D.J.-S.); (C.N.-R.); (R.R.-P.)
| | - Roser Blasco-Gari
- Emergency Service University Hospital de la Plana, 12540 Vila-real, Spain; (L.G.-L.); (D.S.-T.); (M.S.-U.); (P.S.-M.); (G.B.-M.); (R.B.-G.); (D.J.-S.); (C.N.-R.); (R.R.-P.)
| | | | - María Gil-Fortuño
- Microbiology Service University Hospital de la Plana, 12540 Vila-real, Spain; (M.G.-F.); (N.H.-P.); (O.P.-O.)
| | - Noelia Hernández-Pérez
- Microbiology Service University Hospital de la Plana, 12540 Vila-real, Spain; (M.G.-F.); (N.H.-P.); (O.P.-O.)
| | - David Jovani-Sales
- Emergency Service University Hospital de la Plana, 12540 Vila-real, Spain; (L.G.-L.); (D.S.-T.); (M.S.-U.); (P.S.-M.); (G.B.-M.); (R.B.-G.); (D.J.-S.); (C.N.-R.); (R.R.-P.)
| | - Laura López-Diago
- Clinical Analysis Service University Hospital de la Plana, 12540 Vila-real, Spain;
| | - Cristina Notari-Rodríguez
- Emergency Service University Hospital de la Plana, 12540 Vila-real, Spain; (L.G.-L.); (D.S.-T.); (M.S.-U.); (P.S.-M.); (G.B.-M.); (R.B.-G.); (D.J.-S.); (C.N.-R.); (R.R.-P.)
| | - Oscar Pérez-Olaso
- Microbiology Service University Hospital de la Plana, 12540 Vila-real, Spain; (M.G.-F.); (N.H.-P.); (O.P.-O.)
| | | | - Raquel Ruíz-Puig
- Emergency Service University Hospital de la Plana, 12540 Vila-real, Spain; (L.G.-L.); (D.S.-T.); (M.S.-U.); (P.S.-M.); (G.B.-M.); (R.B.-G.); (D.J.-S.); (C.N.-R.); (R.R.-P.)
| | - Alberto Arnedo-Pena
- Public Health Center, 12003 Castelló de la Plana, Spain; (M.R.P.-S.); (M.A.R.-G.)
- Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Department of Health Science, Public University Navarra, 31006 Pamplona, Spain
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Goldstein DS. Post-COVID dysautonomias: what we know and (mainly) what we don't know. Nat Rev Neurol 2024; 20:99-113. [PMID: 38212633 DOI: 10.1038/s41582-023-00917-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
Following on from the COVID-19 pandemic is another worldwide public health challenge that is referred to variously as long COVID, post-COVID syndrome or post-acute sequelae of SARS-CoV-2 infection (PASC). PASC comes in many forms and affects all body organs. This heterogeneous presentation suggests involvement of the autonomic nervous system (ANS), which has numerous roles in the maintenance of homeostasis and coordination of responses to various stressors. Thus far, studies of ANS dysregulation in people with PASC have been largely observational and descriptive, based on symptom inventories or objective but indirect measures of cardiovascular function, and have paid little attention to the adrenomedullary, hormonal and enteric nervous components of the ANS. Such investigations do not consider the syndromic nature of autonomic dysfunction. This Review provides an update on the literature relating to ANS abnormalities in people with post-COVID syndrome and presents a theoretical perspective on how the ANS might participate in common features of PASC.
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Affiliation(s)
- David S Goldstein
- Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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