Sex-differences in the longitudinal recovery of neuromuscular function in COVID-19 associated acute respiratory distress syndrome survivors

Tea Lulic-Kuryllo; Marco Benedini; Marta Cogliati; Alessandro Cudicio; Bruno Guarneri; Stefano Gazzina; Simone Piva; Nicola Latronico; Claudio Orizio; Francesco Negro

doi:10.3389/fmed.2023.1185479

Sex-differences in the longitudinal recovery of neuromuscular function in COVID-19 associated acute respiratory distress syndrome survivors

Front Med (Lausanne). 2023 Jun 26:10:1185479. doi: 10.3389/fmed.2023.1185479. eCollection 2023.

Authors

Affiliations

¹ Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
² Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Lombardia, Italy.
³ Neurophysiology Unit, ASST Spedali Civili University Hospital, Brescia, Lombardia, Italy.
⁴ Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili University Hospital, Brescia, Italy.
⁵ 'Alessandra Bono' University Research Center on Long-Term Outcome (LOTO) in Critical Illness Survivors, University of Brescia, Brescia, Italy.

Abstract

Introduction: Patients admitted to the intensive care unit (ICU) following severe acute respiratory syndrome 2 (SARS-CoV-2) infection may have muscle weakness up to 1 year or more following ICU discharge. However, females show greater muscle weakness than males, indicating greater neuromuscular impairment. The objective of this work was to assess sex differences in longitudinal physical functioning following ICU discharge for SARS-CoV-2 infection.

Methods: We performed longitudinal assessment of physical functioning in two groups: 14 participants (7 males, 7 females) in the 3-to-6 month and 28 participants (14 males, 14 females) in the 6-to-12 month group following ICU discharge and assessed differences between the sexes. We examined self-reported fatigue, physical functioning, compound muscle action potential (CMAP) amplitude, maximal strength, and the neural drive to the tibialis anterior muscle.

Results: We found no sex differences in the assessed parameters in the 3-to-6-month follow-up, indicating significant weakness in both sexes.Sex differences emerged in the 6-to-12-month follow-up. Specifically, females exhibited greater impairments in physical functioning, including lower strength, walking lower distances, and high neural input even 1 year following ICU-discharge.

Discussion: Females infected by SARS-CoV-2 display significant impairments in functional recovery up to 1 year following ICU discharge. The effects of sex should be considered in post-COVID neurorehabilitation.

Keywords: COVID-19; intensive care unit; motor unit; neuromuscular function; sex differeces.