Sex-differences in the Longitudinal Recovery of Neuromuscular Function in COVID-19 Associated Acute Respiratory Distress Syndrome Survivors

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2023 Jul 12

PMID 37435534

Authors

Tea Lulic-Kuryllo

Marco Benedini

Marta Cogliati

Alessandro Cudicio

Bruno Guarneri

Stefano Gazzina

Simone Piva

Nicola Latronico

Claudio Orizio

Francesco Negro

Affiliations

Soon will be listed here.

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.

Citing Articles

Electrophysiological neuromuscular alterations and severe fatigue predict long-term muscle weakness in survivors of COVID-19 acute respiratory distress syndrome.

Benedini M, Cogliati M, Lulic-Kuryllo T, Peli E, Mombelli S, Calza S Front Neurol. 2023; 14:1235734.

PMID: 38073634 PMC: 10702731. DOI: 10.3389/fneur.2023.1235734.

References

Camarri B, Eastwood P, Cecins N, Thompson P, Jenkins S . Six minute walk distance in healthy subjects aged 55-75 years. Respir Med. 2005; 100(4):658-65. DOI: 10.1016/j.rmed.2005.08.003. View

van Gassel R, Bels J, Remij L, van Bussel B, Posthuma R, Gietema H . Functional Outcomes and Their Association With Physical Performance in Mechanically Ventilated Coronavirus Disease 2019 Survivors at 3 Months Following Hospital Discharge: A Cohort Study. Crit Care Med. 2021; 49(10):1726-1738. PMC: 8439632. DOI: 10.1097/CCM.0000000000005089. View

Dorfman L, Howard J, McGill K . Motor unit firing rates and firing rate variability in the detection of neuromuscular disorders. Electroencephalogr Clin Neurophysiol. 1989; 73(3):215-24. DOI: 10.1016/0013-4694(89)90122-3. View

Baker A, Maffitt N, Del Vecchio A, McKeating K, Baker M, Baker S . Neural dysregulation in post-COVID fatigue. Brain Commun. 2023; 5(3):fcad122. PMC: 10257363. DOI: 10.1093/braincomms/fcad122. View

Huang C, Huang L, Wang Y, Li X, Ren L, Gu X . 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021; 397(10270):220-232. PMC: 7833295. DOI: 10.1016/S0140-6736(20)32656-8. View

de Jonghe B, Sharshar T, Lefaucheur J, Authier F, Durand-Zaleski I, Boussarsar M . Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002; 288(22):2859-67. DOI: 10.1001/jama.288.22.2859. View

Christie A, Kamen G . Short-term training adaptations in maximal motor unit firing rates and afterhyperpolarization duration. Muscle Nerve. 2009; 41(5):651-60. DOI: 10.1002/mus.21539. View

Latronico N, Peli E, Calza S, Rodella F, Novelli M, Cella A . Physical, cognitive and mental health outcomes in 1-year survivors of COVID-19-associated ARDS. Thorax. 2021; 77(3):300-303. DOI: 10.1136/thoraxjnl-2021-218064. View

Latronico N, Bolton C . Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol. 2011; 10(10):931-41. DOI: 10.1016/S1474-4422(11)70178-8. View

10.

Lulic-Kuryllo T, Inglis J . Sex differences in motor unit behaviour: A review. J Electromyogr Kinesiol. 2022; 66:102689. DOI: 10.1016/j.jelekin.2022.102689. View

11.

Lemos-Filho L, Mikkelsen M, Martin G, Dabbagh O, Adesanya A, Gentile N . Sex, race, and the development of acute lung injury. Chest. 2012; 143(4):901-909. PMC: 3747719. DOI: 10.1378/chest.12-1118. View

12.

Kamal M, Abo Omirah M, Hussein A, Saeed H . Assessment and characterisation of post-COVID-19 manifestations. Int J Clin Pract. 2020; 75(3):e13746. PMC: 7536922. DOI: 10.1111/ijcp.13746. View

13.

Negro F, Muceli S, Castronovo A, Holobar A, Farina D . Multi-channel intramuscular and surface EMG decomposition by convolutive blind source separation. J Neural Eng. 2016; 13(2):026027. DOI: 10.1088/1741-2560/13/2/026027. View

14.

Tankisi H, Tankisi A, Harbo T, Markvardsen L, Andersen H, Pedersen T . Critical illness myopathy as a consequence of Covid-19 infection. Clin Neurophysiol. 2020; 131(8):1931-1932. PMC: 7834604. DOI: 10.1016/j.clinph.2020.06.003. View

15.

Jolley S, Bunnell A, Hough C . ICU-Acquired Weakness. Chest. 2016; 150(5):1129-1140. PMC: 5103015. DOI: 10.1016/j.chest.2016.03.045. View

16.

Cogliati M, Cudicio A, Toscani F, Gaffurini P, Bissolotti L, Orizio C . Normalized maximal rate of torque development during voluntary and stimulated static contraction in human tibialis anterior: Influence of age. Exp Gerontol. 2020; 138:110999. DOI: 10.1016/j.exger.2020.110999. View

17.

Valentin A, Jordan B, Lang T, Hiesmayr M, Metnitz P . Gender-related differences in intensive care: a multiple-center cohort study of therapeutic interventions and outcome in critically ill patients. Crit Care Med. 2003; 31(7):1901-7. DOI: 10.1097/01.CCM.0000069347.78151.50. View

18.

Piasecki J, Inns T, Bass J, Scott R, Stashuk D, Phillips B . Influence of sex on the age-related adaptations of neuromuscular function and motor unit properties in elite masters athletes. J Physiol. 2020; 599(1):193-205. DOI: 10.1113/JP280679. View

19.

Taylor C, Kopicko B, Negro F, Thompson C . Sex differences in the detection of motor unit action potentials identified using high-density surface electromyography. J Electromyogr Kinesiol. 2022; 65:102675. PMC: 10807372. DOI: 10.1016/j.jelekin.2022.102675. View

20.

Wu R, Sung W, Cheng H, Yeh H . Investigating the rate of skeletal muscle atrophy in men and women in the intensive care unit: a prospective observational study. Sci Rep. 2022; 12(1):16629. PMC: 9534861. DOI: 10.1038/s41598-022-21052-3. View