ABSTRACT
Background: Persistent COVID-19 symptoms have been reported up to six months (M6) after hospital discharge. Little is known on the frequency and the nature of persistent symptoms beyond M6. Here we assessed, in the longitudinal prospective French COVID-19 cohort, symptoms that persisted twelve months after admission for COVID-19. Methods: Hospitalized patients with a virologically-confirmed COVID-19 were enrolled. Follow-up was planned with a physician's visit at M3, M6 and M12 post-admission. At M12, manual assessment of muscle strength of each limb was assessed using the modified Medical Muscle Research council Scale for testing muscle strength (mMRC). Patients were also interviewed on health-related quality-of-life (SF-12) and on psychological distress (HADS). Associations between persistence of ≥ 3 symptoms at M12 and clinical characteristics at admission were assessed through bivariate and multivariate logistic regression. Results: By September 2021, M12 data were available for 737 patients enrolled between February 3rd and July 15th 2020. Median age was 61 years, 64% were men and 37% were admitted to intensive care unit during the acute phase. At M12 visit, 27% of participants had ≥ 3 symptoms, with no change between M6 and M12 globally. Fatigue (46%), dyspnea (33%) and joint pain (21%) were the 3 most frequently reported symptoms. Presence of ≥ 3 symptoms was associated with both anxiety and depression, an impaired quality of life and mMRC scale < 57. The mean percentage of predicted value of distance walked in 6 min (6MWT) was 88% (IQR 74-100) for the 163 patients who realised the 6MWT, this percentage was lower in patients who reported dyspnea (85% [IQR 71;99] vs 95% [IQR 76;101], p=0.04). Compared to men, women more often reported presence of ≥ 3 symptoms (39% vs 21%), depression and anxiety (respectively, 12% vs 6% and 21% vs 10%), an altered quality of life for the physical component only (54% vs 46%), and a slight or a moderate disability (respectively, 20% vs 14% and 6% vs 4%). Women had less often returned to work than men (34% vs 23%). Conclusion: A fourth of individuals admitted to hospital for COVID-19 still had ≥3 persistent symptoms at M12 post-discharge, with no improvement between M6 and M12. Also, 25% of those who initially had a professional occupation were not back to work at M12. Women reported more often ≥3 symptoms, suffered more from anxiety and depression, and had less often returned to work than men.
ABSTRACT
Background: Lower risk of COVID-19 was reported in men with prostate cancer receiving androgen deprivation therapy while low levels of testosterone (T) were associated with a more severe disease and poor clinical outcomes in COVID-19 male patients (pts). In the latter case, it is unclear whether low levels of T and dihydrotestoserone (DHT) are risk factors or consequences of COVID-19. Here, we investigated T and DHT levels impact on COVID-19 severity in ambispective cohorts of symptomatic SARS-CoV-2 infected males. Methods: Both prospective (European Hospital Georges Pompidou patients, P-cohort) and retrospective (French COVID-19 cohort, REacting project, R-cohort) cohorts included male pts admitted for severe COVID-19. The P-cohort included pts admitted in a medical unit (non-ICU) or in ICU immediately (ICU-I). The R-cohort included pts admitted to a medical unit, ICU-I or to ICU secondarily (ICU-S). The size of ICU-S pts group in P-cohort was insufficient to include their data in the analysis. We collected information on pts demographics and COVID-19-related outcomes. T, DHT levels and inflammation markers were measured. Wilcoxon-Mann-Whitney test and chi2-test (or Fisher’s exact test, if appropriate) were performed. All tests were two-sided at 0.05 significance level. Results: The P-cohort included 71 pts (median age: 64 years) and the R-cohort 89 pts (median age: 62 years). The median duration between admission and measurement of hormone levels was 2 days (range: 0-16) and 0.5 days (range: 0-11) respectively. T and DHT levels were low in all pts as compared to standards and even lower in ICU pts (Table). In the R-cohort, T and DHT lowest values were observed for ICU-I pts and median values for ICU-S pts. [Formula presented] Conclusions: Low T and DHT levels were associated with the severity of the disease and the poorest clinical outcomes in males with severe COVID-19. This suggests that COVID-19 may cause a rapid and profound decrease in androgens levels and that T and DHT serum levels may be used as prognostic markers. Legal entity responsible for the study: Pr. Stéphane Oudard. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.