Sex and age affect acute and persisting COVID-19 illness

Abstract

Long COVID is associated with neurological and neuropsychiatric manifestations. We conducted an observational study on 97 patients with prior SARS-CoV-2 infection and persisting cognitive complaints that presented to the University Health Network Memory Clinic between October 2020 and December 2021. We assessed the main effects of sex, age, and their interaction on COVID-19 symptoms and outcomes. We also examined the relative contribution of demographics and acute COVID-19 presentation (assessed retrospectively) on persistent neurological symptoms and cognition. Among our cohort, males had higher hospitalization rates than females during the acute COVID-19 illness (18/35 (51%) vs. 15/62 (24%); P = .009). Abnormal scores on cognitive assessments post-COVID were associated with older age (AOR = 0.84; 95% CI 0.74–0.93) and brain fog during initial illness (AOR = 8.80; 95% CI 1.76–65.13). Female sex (ARR = 1.42; 95% CI 1.09–1.87) and acute shortness of breath (ARR = 1.41; 95% CI 1.09–1.84) were associated with a higher risk of experiencing more persistent short-term memory symptoms. Female sex was the only predictor associated with persistent executive dysfunction (ARR = 1.39; 95% CI 1.12–1.76) and neurological symptoms (ARR = 1.66; 95% CI 1.19–2.36). Sex differences were evident in presentations and cognitive outcomes in patients with long COVID.

Immune Response after SARS-CoV-2 Infection with Residual Post-COVID Symptoms

“…Lastly, the study had a higher representation of female participants. Numerous research studies [ 51 , 52 ] have indicated that females exhibit more symptoms than males, not only during the initial phase but also in the subsequent follow-up period. Males face an elevated likelihood of hospitalization and ICU admission, suggesting a greater potential for severe acute illness.…”

Iron dysregulation and inflammatory stress erythropoiesis associates with long-term outcome of COVID-19

“… 6 – 8 )—including the efficacy of the innate antiviral response—implying that poor viral control perpetuating ongoing inflammation, acute respiratory distress and end-organ damage may predispose individuals to ongoing symptomatology. Various predictors of PASC have been suggested, including female sex 7 , 9 – 12 , increased viral load at presentation 10 , lower peak SARS-CoV-2 antibody titers 6 , 7 , increased duration of hospital stay 13 and reactivation of latent Epstein–Barr virus infection 14 , 15 . Immune changes persisting for months following COVID-19 have also been detected 16 – 19 , although it is unclear whether these drive PASC or are independently reflective of acute disease severity.…”

Altered metabolites in the periaqueductal gray of COVID-19 patients experiencing headaches: a longitudinal MRS study

“…The aim of the present study was to investigate the alterations in metabolites of PAG pre-and post-COVID-19 infection in individuals who suffered from headaches during the acute phase of the disease, utilizing 1 H-MRS technology. Furthermore, due to the observed gender disparities in COVID-19 and the greater incidence of headaches in female patients (16)(17)(18)(19), the current study selectively enrolled female subjects to mitigate potential sex-related biases and improve the accuracy of the findings.…”