Метаболический сдвиг- на примере военных
В Швейцарии провели исследование среди военнослужащих (18-29 лет)- как повлиял на них перенесенный ковид в долгосрочной перспективе (6+месяцев). Средний возраст участников исследования- 21 год, практически здоровые, 95% - мужчины. Ковидом болели легко или умеренно. Постковида как такового, среди переболевших не было. Присутствовал и не болеший контроль, и, так же, те, кто болел ковидом менее чем 6 месяцев тому, и те, кто переболели асимптоматично ( т.е они не помнят чтоб болели и когда, но антитела у них есть).
С точки зрения авторов, у переболевших ковидом по сравнению с контролем наблюдается небольшой, однако достоверный и не особо приятный метаболический сдвиг: у них повышенный уровень холестерина, и липопротеина низкой плотности, повышенный индекс массы тела, пониженная устойчивость к кардиореспираторныи нагрузкам, более низкий уровень тестостерона. "Психологические" тесты показали, что у них чаще отмечается "хроническая усталость". У тех, кто переболел "недавно", чаще отмечается тревожность, выше симптоматика ПТСР и депрессии, и больше нарушений обоняния. У мужчин проверили еще и качество спермы, и у тех, кто болел менее чем 6 мес. тому, чаще была нарушена подвижность сперматозоидов (по сравнению с теми кто более более чем 6 мес тому, или не болевшими). Через полгода, достоверных отличий между болевшими и здоровыми по этому параметру- не было.
У тех, кто переболел, в крови было мало нейтрализующих антител. Ассоциации между тяжестью болезни и выработавшимся иммуннитетом не обнаружено. У привитых, но заболевших, титры антител в крови были выше в 10 раз, чем у непривитых.
Конечно, эти "постковидные" изменения вовсе не обязательно связаны с ковидом- тк до ковида никто ничего такого не мерял, есть вероятность, что люди с такими метаболическими "склонностями" оказались более уязвимы к коронавирусу, ну и все эти особенности и были, и остались .
В то же время, нельзя определенно сказать, что это не последствия болезни " у молодых здоровых".
Так что лучше переболевшим, даже не тяжело, внимательно следить за здоровьем.
[Spoiler (click to open)]
We aimed to describe sequelae presenting more than six months after COVID-19 in non-hospitalized young adults. Methods: A prospective, longitudinal cohort study followed-up on young Swiss Armed Forces (SAF) personnel. The comprehensive test battery was administered during a single full day of testing at the University of Zurich. It quantified the impact of SARS-CoV-2 infection on cardiovascular, pulmonary, neurological, renal, ophthalmological, male reproductive, psychological, and general health in addition to laboratory parameters. Results: We included 501 participants (5.6% females) with a median age of 21 years (range 19-29). Cases of previous COVID -19 (>6 months (mean 10 months) since diagnosis, n=177) were compared with never infected controls (n=248). We also included more recent COVID-19 cases (≤6 months, n=19) and asymptomatically infected individuals (n=49). This comprehensive test series (evaluating cardio-vascular, pulmonary, neurological, ophthalmological, male fertility, psychological and general systems), administered more than 6 months after COVID-19 infection, showed significant sequelae; higher body mass index, dyslipidemia, and lower physical endurance. Such a constellation suggests that previously healthy young adults may have a higher risk of developing metabolic disorders and possible cardiovascular complications. Otherwise, the results of these quantitative analyses show overall recovery from mild COVID-19 and resolution of most sequelae at a mean of > 10 months post-infection. To date, this is the most comprehensive, controlled study, with the longest follow-up of sequelae in young, previously healthy adults. The multi-system impact of mild COVID-19 in this cohort with a mean age of 21 years,appears to be far less than that seen in older, multi-morbid or hospitalized patients. Overall, this is a positive perspective for young adult populations globally who have been infected with SARS-CoV-2. Regarding male fertility, it has been postulated that a SARS-CoV-2 infection may have potentially detrimental impact (20). In our subgroup analyses, we found evidence that recent infections (< 6 months before testing) were associated with poorer motile sperm counts but that this was no longer significant for non-recent infections. Our findings are corroborated by other studies. Donders et al found sperm quality to be sub-optimal post COVID-19 disease with an estimated recovery time of 3 months (21). In addition, we found significant hyposomia (TDI <31) in those infected in the previous 6 months. Observational studies of SARS-CoV-2 infected persons also report high levels of hyposomia. We recently followed up on army personnel using an App to self-report symptoms and found that positive-tested persons had a significantly reduced “sense of smell” (OR 18.24; 95% CI: 4.23, 78.69; p=0.00) compared to non-infected and that the hypogeusia persisted for a mean of 6.4 weeks (22). In addition, we found STAI S scores of anxiety levels to be significantly higher in recent COVID-19 participants. In an earlier study, Mazza et al (23) used questionnaires to screen for psychiatric symptoms in 402 adults one month post COVID-19 infection. A significant proportion of the participants self-rated in the psychopathological range for post-traumatic stress disorder (PTSD) (28%), depression (31%), anxiety (42%) and insomnia (40%). In our study, there were no significant differences in psychosocial questionnaire results between controls and those who had been infected more than six months previously. We consider the sequelae persisting beyond 6 months to be particularly important especially the excess burden of metabolic disorders including the elevated low-density lipoprotein and elevated total cholesterol. Our study could not differentiate whether COVID-19 in young adults predisposes for metabolic disorders or whether this predisposition existed previously and was accentuated by the infection. An earlier evaluation of the US Department of Veteran Affairs national healthcare database (6) found a substantial burden of health loss including diagnoses, medication use and laboratory abnormalities in patients with COVID-19 who survived at least for 30 days after diagnosis. The sequelae risk gradient increased according to the severity of the acute COVID-19 infection. Disorders of lipid metabolism were identified and an excess burden of use of antilipemic agents (6). Our findings also highlight lower physical endurance persisting many months post infection with significantly lower aerobic threshold (p=0.007). An earlier study of aerobic capacity in young Swiss army recruits (median age 21 years) (24), compared the results of physical endurance tests before infection to the same tests conducted 45 days post infection and found a significant decline in predicted maximal aerobic capacity in COVID-19 convalescent recruits. Our results suggest that this reduction in physical endurance can persist for longer than six months and we advocate further follow-up to define the duration of this sequela. Even mild infections with SARSCoV- 2 should not be underestimated (6,22,24). With the circulation of highly transmissible variants such as Omicron, a reduction in public health mitigation measures, a resumption of social activities (25), more and more young adults will have contact with SARS-CoV-2 and must live with consequences. Our study highlighted a positive sequela of COVID -19 showing that vaccinated, recovered individuals exhibited a high titer of nAb, regardless of the severity of the course of the previous infection. This further underpins the need to vaccinate persons recovered from COVID-19 regardless of the severity of their infection. The economic costs of even mild, long term COVID-19 sequelae and associated loss of productivity and possible need for disability allowances have still to be elucidated.
С точки зрения авторов, у переболевших ковидом по сравнению с контролем наблюдается небольшой, однако достоверный и не особо приятный метаболический сдвиг: у них повышенный уровень холестерина, и липопротеина низкой плотности, повышенный индекс массы тела, пониженная устойчивость к кардиореспираторныи нагрузкам, более низкий уровень тестостерона. "Психологические" тесты показали, что у них чаще отмечается "хроническая усталость". У тех, кто переболел "недавно", чаще отмечается тревожность, выше симптоматика ПТСР и депрессии, и больше нарушений обоняния. У мужчин проверили еще и качество спермы, и у тех, кто болел менее чем 6 мес. тому, чаще была нарушена подвижность сперматозоидов (по сравнению с теми кто более более чем 6 мес тому, или не болевшими). Через полгода, достоверных отличий между болевшими и здоровыми по этому параметру- не было.
У тех, кто переболел, в крови было мало нейтрализующих антител. Ассоциации между тяжестью болезни и выработавшимся иммуннитетом не обнаружено. У привитых, но заболевших, титры антител в крови были выше в 10 раз, чем у непривитых.
Конечно, эти "постковидные" изменения вовсе не обязательно связаны с ковидом- тк до ковида никто ничего такого не мерял, есть вероятность, что люди с такими метаболическими "склонностями" оказались более уязвимы к коронавирусу, ну и все эти особенности и были, и остались .
В то же время, нельзя определенно сказать, что это не последствия болезни " у молодых здоровых".
Так что лучше переболевшим, даже не тяжело, внимательно следить за здоровьем.
[Spoiler (click to open)]
We aimed to describe sequelae presenting more than six months after COVID-19 in non-hospitalized young adults. Methods: A prospective, longitudinal cohort study followed-up on young Swiss Armed Forces (SAF) personnel. The comprehensive test battery was administered during a single full day of testing at the University of Zurich. It quantified the impact of SARS-CoV-2 infection on cardiovascular, pulmonary, neurological, renal, ophthalmological, male reproductive, psychological, and general health in addition to laboratory parameters. Results: We included 501 participants (5.6% females) with a median age of 21 years (range 19-29). Cases of previous COVID -19 (>6 months (mean 10 months) since diagnosis, n=177) were compared with never infected controls (n=248). We also included more recent COVID-19 cases (≤6 months, n=19) and asymptomatically infected individuals (n=49). This comprehensive test series (evaluating cardio-vascular, pulmonary, neurological, ophthalmological, male fertility, psychological and general systems), administered more than 6 months after COVID-19 infection, showed significant sequelae; higher body mass index, dyslipidemia, and lower physical endurance. Such a constellation suggests that previously healthy young adults may have a higher risk of developing metabolic disorders and possible cardiovascular complications. Otherwise, the results of these quantitative analyses show overall recovery from mild COVID-19 and resolution of most sequelae at a mean of > 10 months post-infection. To date, this is the most comprehensive, controlled study, with the longest follow-up of sequelae in young, previously healthy adults. The multi-system impact of mild COVID-19 in this cohort with a mean age of 21 years,appears to be far less than that seen in older, multi-morbid or hospitalized patients. Overall, this is a positive perspective for young adult populations globally who have been infected with SARS-CoV-2. Regarding male fertility, it has been postulated that a SARS-CoV-2 infection may have potentially detrimental impact (20). In our subgroup analyses, we found evidence that recent infections (< 6 months before testing) were associated with poorer motile sperm counts but that this was no longer significant for non-recent infections. Our findings are corroborated by other studies. Donders et al found sperm quality to be sub-optimal post COVID-19 disease with an estimated recovery time of 3 months (21). In addition, we found significant hyposomia (TDI <31) in those infected in the previous 6 months. Observational studies of SARS-CoV-2 infected persons also report high levels of hyposomia. We recently followed up on army personnel using an App to self-report symptoms and found that positive-tested persons had a significantly reduced “sense of smell” (OR 18.24; 95% CI: 4.23, 78.69; p=0.00) compared to non-infected and that the hypogeusia persisted for a mean of 6.4 weeks (22). In addition, we found STAI S scores of anxiety levels to be significantly higher in recent COVID-19 participants. In an earlier study, Mazza et al (23) used questionnaires to screen for psychiatric symptoms in 402 adults one month post COVID-19 infection. A significant proportion of the participants self-rated in the psychopathological range for post-traumatic stress disorder (PTSD) (28%), depression (31%), anxiety (42%) and insomnia (40%). In our study, there were no significant differences in psychosocial questionnaire results between controls and those who had been infected more than six months previously. We consider the sequelae persisting beyond 6 months to be particularly important especially the excess burden of metabolic disorders including the elevated low-density lipoprotein and elevated total cholesterol. Our study could not differentiate whether COVID-19 in young adults predisposes for metabolic disorders or whether this predisposition existed previously and was accentuated by the infection. An earlier evaluation of the US Department of Veteran Affairs national healthcare database (6) found a substantial burden of health loss including diagnoses, medication use and laboratory abnormalities in patients with COVID-19 who survived at least for 30 days after diagnosis. The sequelae risk gradient increased according to the severity of the acute COVID-19 infection. Disorders of lipid metabolism were identified and an excess burden of use of antilipemic agents (6). Our findings also highlight lower physical endurance persisting many months post infection with significantly lower aerobic threshold (p=0.007). An earlier study of aerobic capacity in young Swiss army recruits (median age 21 years) (24), compared the results of physical endurance tests before infection to the same tests conducted 45 days post infection and found a significant decline in predicted maximal aerobic capacity in COVID-19 convalescent recruits. Our results suggest that this reduction in physical endurance can persist for longer than six months and we advocate further follow-up to define the duration of this sequela. Even mild infections with SARSCoV- 2 should not be underestimated (6,22,24). With the circulation of highly transmissible variants such as Omicron, a reduction in public health mitigation measures, a resumption of social activities (25), more and more young adults will have contact with SARS-CoV-2 and must live with consequences. Our study highlighted a positive sequela of COVID -19 showing that vaccinated, recovered individuals exhibited a high titer of nAb, regardless of the severity of the course of the previous infection. This further underpins the need to vaccinate persons recovered from COVID-19 regardless of the severity of their infection. The economic costs of even mild, long term COVID-19 sequelae and associated loss of productivity and possible need for disability allowances have still to be elucidated.