Post-COVID-19 illness and associations with sex and gender
Authors: Mangion Kenneth , Morrow Andrew J. , Sykes Robert , Kamdar Anna , Bagot Catherine , Bruce George , Connelly Paul , Delles Christian , Gibson Vivienne B. , Gillespie Lynsey , Barrientos Pauline Hall , Lennie Vera , Roditi Giles , Sattar Naveed , Stobo David , Allwood-Spiers Sarah , McConnachie Alex , Berry Colin ,   CISCO-19 investigators, Blyth Kevin G. , Briscoe Michael , Church Colin , Dobbin Stephen , Gillis Keith , Ho Antonia , Lowe David J. , Mayne Kaitlin J. , Mark Patrick B. , McGinley Christopher , McKee Connor , Peck Oliver , Rankin Alastair J. , Rooney Claire , Spiers Sarah A. , Stobo David , Wereski Ryan , Wright Sylvia , Abel Lynn , Grieve Douglas , Bayes Hannah , Carberry Jaclyn , Doherty Daniel , Ferguson Ian , Goldie Fraser , Knox Laura , Scot Katherine , Stobo David , Sharma Varun , Brown Ammani , Dougherty Andrew , Fallon Kirsty , Gilmour Lesley , Cowan Chloe , Kean Sharon , Van-Melckebeke Jurgen , Moran-Jones Kim , Stuart Debra , Travers Maureen , Hopkins Tracey , Dymock Laura , McLennan Evonne , Woodward Rosemary , Savage Fiona , Tynan Nicola , Chang Sau Lee , Dupre Mhairi , Norton Lindsey , Peng Liam , Orange Clare , Gunson Rory , Gonzalez-Lopez Rosario , Stace Rebecca , Butler Elaine , Lees Jennifer S. , Touyz Rhian M. , Welsh Paul , Palmarini Massimo , Cleland John G. F. , Kean Sharon , Kelly Bernard , McIntosh Alasdair , Russell Dionne , Weeden Sarah , Macfarlane Peter W. , Inglis Louise , Watt Jean , McLaren Kathryn , Latif Shahid , Hill Nick , Husmeier Dirk , Luo Xiaoyu , Kellman Peter , Xue Hui , Collinsworth Amy , Mullen Sarah , Rogers Campbell , Bulluck Heerajnarain , Carrick David , Corcoran David , Findlay Iain , Lang Ninian N. , McGeoch Ross , Nordin Sabrina , Payne Alexander , Robertson Keith , Ryan Nicola , Veldtman Gruschen , Weir Robin P. , Watkins Stuart , Basu Neil , McInnes Iain , Siebert Stefan 
Published: August 2023

Abstract
Background
Post-COVID-19 syndromes have associated with female sex, but the pathophysiological basis is uncertain.

Aim
There are sex differences in myocardial inflammation identified using cardiac magnetic resonance (CMR) in post-COVID-19 patients, and in patient reported health outcomes following COVID-19 infection.

Design
This prospective study investigated the time-course of multiorgan injury in survivors of COVID-19 during convalescence.

Methods
Clinical information, blood biomarkers, and patient reported outcome measures were prospectively acquired at enrolment (visit 1) and 28–60 days post-discharge (visit 2). Chest computed tomography (CT) and CMR were performed at visit 2. Follow-up was carried out for serious adverse events, including death and rehospitalization.

Results
Sixty-nine (43%) of 159 patients recruited were female. During the index admission, females had a lower peak C-reactive protein (74 mg/l (21,163) versus 123 mg/l (70, 192) p = 0.008) and peak ferritin (229 μg/l (103, 551) versus 514 μg/l (228, 1122) p < 0.001). Using the Modified Lake-Louise criteria, females were more likely to have definite evidence of myocardial inflammation (54% (37/68) versus 33% (30/90) p = 0.003). At enrolment and 28–60 days post-discharge, enhanced illness perception, higher levels of anxiety and depression and lower predicted maximal oxygen utilization occurred more commonly in women. The mean (SD, range) duration of follow-up after hospital discharge was 450 (88) days (range 290, 627 days). Compared to men, women had lower rates of cardiovascular hospitalization (0% versus 8% (7/90); p = 0.018).

Conclusions
Women demonstrated worse patient reported outcome measures at index admission and 28–60 days follow-up though cardiovascular hospitalization was lower.