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Fierro P, Martín D, Pariente-Rodrigo E, Pini SF, Basterrechea H, Tobalina M, Petitta B, Bianconi C, Díaz-Salazar S, Bonome M, Ramos-Barrón C, Hernández-Hernández JL. Post-COVID-19 syndrome, inflammation and insulin resistance: a retrospective cohort study. Minerva Endocrinol (Torino) 2024:S2724-6507.23.04108-8. [PMID: 38656093 DOI: 10.23736/s2724-6507.23.04108-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND COVID-19-induced diabetes is a novel and enigmatic disease. Our aim was to evaluate a possible relationship between post-COVID-19 syndrome (PCS) and increased insulin resistance (IR) in non-diabetic outpatients after mild COVID-19. METHODS Repeated measures design. Three evaluations [1E (pre-COVID, baseline), 2E (3 months post-COVID) and 3E (21 months post-COVID)] were performed, directed to PCS+ and PCS- subjects. Triglyceride-glucose (TyG) index ≥8.74 was considered IR, and albumin-to-globulin ratio (AGR) <1.50, inflammation. RESULTS We analyzed 112 individuals (median [IQR] age=44 [20] years, 58% women, 36 PCS+, 76 PCS-). PCS+ with very low basal IR (TyG <7.78, lowest quartile) showed a reduced inflammatory burden (basal AGR=1.81 [0.4] vs. 1.68 [0.2] in 2E; P=0.23), and increased TyG across evaluations (from basal 7.62 [0.2] to 8.29 [0.5]; P=0.018]. Conversely, PCS+ subjects with high basal TyG (TyG ≥8.65, highest quartile) did not show significant variations in TyG, but a greater inflammatory load (basal AGR=1.69 [0.3] vs. 1.44 [0.3] in 2E; P=0.10). In multivariable models addressing groups with reduced basal IR (TyG <8.01), PCS has been a consistent predictor for TyG, after adjusting for confounders. Partial correlation and multivariable analyses showed similarities involving acute polysymptomatic COVID-19 and PCS regarding IR. CONCLUSIONS PCS was associated with increased IR, being more evident when the baseline degree of IR was very low. PCS and increased IR were separately associated with inflammation. Acute polysymptomatic COVID-19 and PCS could be clinical expressions of underlying inflammatory state, which in turn may also trigger IR.
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Affiliation(s)
- Patricia Fierro
- Camargo Interior Primary Care Center, Cantabrian Health Service, Muriedas, Spain
| | - David Martín
- Camargo Costa Primary Care Center, Cantabrian Health Service, Maliaño, Spain
| | | | - Stefanie F Pini
- Hospital at Home Department, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Héctor Basterrechea
- Camargo Interior Primary Care Center, Cantabrian Health Service, Muriedas, Spain
| | | | - Benedetta Petitta
- Camargo Interior Primary Care Center, Cantabrian Health Service, Muriedas, Spain
| | - Camila Bianconi
- Camargo Interior Primary Care Center, Cantabrian Health Service, Muriedas, Spain
| | | | - Merelyn Bonome
- Camargo Interior Primary Care Center, Cantabrian Health Service, Muriedas, Spain
| | - Carmen Ramos-Barrón
- Camargo Costa Primary Care Center, Cantabrian Health Service, Maliaño, Spain
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Díaz-Salazar S, Navas R, Sainz-Maza L, Fierro P, Maamar M, Artime A, Basterrechea H, Petitta B, Pini S, Olmos JM, Ramos C, Pariente E, Hernández JL. Blood group O is associated with post-COVID-19 syndrome in outpatients with a low comorbidity index. Infect Dis (Lond) 2022; 54:897-908. [DOI: 10.1080/23744235.2022.2115548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Sara Díaz-Salazar
- Camargo Interior - Primary Care Center. Servicio Cántabro de Salud, Muriedas, Spain
| | - Raquel Navas
- Camargo Costa – Primary Care Center. Servicio Cántabro de Salud, Maliaño, Spain
| | - Laura Sainz-Maza
- Camargo Costa – Primary Care Center. Servicio Cántabro de Salud, Maliaño, Spain
| | - Patricia Fierro
- Camargo Interior - Primary Care Center. Servicio Cántabro de Salud, Muriedas, Spain
| | - Meryam Maamar
- Emergency Service. Osakidetza. Servicio Vasco de Salud, Bilbao, Spain
| | - Arancha Artime
- El Llano - Primary Care Center. SESPA- Servicio Asturiano de Salud, Gijón, Spain
| | - Héctor Basterrechea
- Camargo Interior - Primary Care Center. Servicio Cántabro de Salud, Muriedas, Spain
| | - Benedetta Petitta
- Camargo Interior - Primary Care Center. Servicio Cántabro de Salud, Muriedas, Spain
| | - Stefanie Pini
- Hospital at Home Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - José Manuel Olmos
- Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Spain
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla. Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Carmen Ramos
- Camargo Costa – Primary Care Center. Servicio Cántabro de Salud, Maliaño, Spain
- Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Spain
| | - Emilio Pariente
- Camargo Interior - Primary Care Center. Servicio Cántabro de Salud, Muriedas, Spain
- Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Spain
| | - José Luis Hernández
- Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Spain
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla. Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
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Maamar M, Artime A, Pariente E, Fierro P, Ruiz Y, Gutiérrez S, Tobalina M, Díaz-Salazar S, Ramos C, Olmos JM, Hernández JL. Post-COVID-19 syndrome, low-grade inflammation and inflammatory markers: a cross-sectional study. Curr Med Res Opin 2022; 38:901-909. [PMID: 35166141 PMCID: PMC8935459 DOI: 10.1080/03007995.2022.2042991] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Post-COVID syndrome (PCS) is a poorly known entity. An underlying chronic, low-grade inflammation (LGI) has been theorized as a pathophysiological mechanism. Available data on biomarkers in PCS show conflicting results. Our aim was to know whether subjects with PCS present higher levels of inflammatory markers, after a mild COVID-19. METHODS Analytical cross-sectional study. Cases of mild COVID-19 in a community setting were included. We collected epidemiological data (age, sex, BMI, smoking, comorbidities), variables of the acute COVID-19 (duration, symptoms), and data at 3 months after the acute phase (symptoms and laboratory test). Serum C-reactive protein (CRP), neutrophil and lymphocyte counts, neutrophil/lymphocyte ratio (NLR), lactate dehydrogenase, ferritin, fibrinogen, and D-dimer levels were analysed. LGI was defined as CRP >0.3 and <1.0 mg/dL. A subject was classified as PCS + if presented signs and symptoms >12 weeks after an infection consistent with COVID-19. Five composite indices (C1-C5) were developed, combining the upper ranges of biomarkers distributions. Multivariate analyses were performed. RESULTS We analysed 121 mild COVID-19 cases (mean age = 45.7 years, 56.2% women). Among the acute symptoms, women presented a higher frequency of fatigue (54.4% vs 30.2%; p = .008). PCS affected 35.8% of women and 20.8% of men (p = .07), and the most reported symptoms were fatigue (42.8%), anosmia (40%), ageusia (22.8%), dyspnea (17.1%) and myalgia (11.4%). Neutrophil count, NLR, CRP and fibrinogen showed the best correlations with PCS and were selected to develop the indices. In women PCS+, C1, C3 and C4 indices were more frequently met, while in men PCS+, C2, C5 and CRP were in the range of LGI. Anosmia, ageusia and fatigue were related to higher neutrophil counts, with sex differences. Fibrinogen levels were higher in persistent myalgia (510 ± 82 mg/dL vs 394 ± 87; p = .013). In multivariable analysis, a woman with a neutrophil count above the median, or with fibrinogen level or NLR in the highest tertile, had a 4-5-fold increased risk of prevalent PCS. A man with CRP in the range of LGI, or fibrinogen level or a neutrophil count in the highest tertile, had a 10-17-fold increased risk of prevalent PCS. CONCLUSIONS The data obtained in the present cross-sectional study seems to demonstrate a consistent association between PCS and upper ranges of the neutrophil count, NLR, fibrinogen, and CRP in the LGI range. Furthermore, composite indices appear useful in detecting relationships between slight elevations of biomarkers and PCS, and our study identifies relevant sex differences in symptoms and markers regarding the PCS.
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Affiliation(s)
- Meryam Maamar
- Emergency Service. Osakidetza, Servicio Vasco de Salud, Bilbao, País Vasco, Spain
| | - Arancha Artime
- El Llano - Primary Health Care Center, SESPA - Servicio Asturiano de Salud, Gijón Asturias, Spain
| | - Emilio Pariente
- Camargo Interior - Primary Health Care Center, Servicio Cántabro de Salud, Muriedas, Cantabria, Spain
- Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, Spain
- CONTACT Emilio Pariente “Camargo Interior” Primary Care Center, Associate Professor, University of Cantabria, Avda Bilbao, s/n. 39600-Muriedas, Cantabria, Spain
| | - Patricia Fierro
- Camargo Interior - Primary Health Care Center, Servicio Cántabro de Salud, Muriedas, Cantabria, Spain
| | - Yolanda Ruiz
- Camargo Interior - Primary Health Care Center, Servicio Cántabro de Salud, Muriedas, Cantabria, Spain
| | - Silvia Gutiérrez
- Camargo Interior - Primary Health Care Center, Servicio Cántabro de Salud, Muriedas, Cantabria, Spain
| | - Marian Tobalina
- Camargo Interior - Primary Health Care Center, Servicio Cántabro de Salud, Muriedas, Cantabria, Spain
| | - Sara Díaz-Salazar
- Camargo Interior - Primary Health Care Center, Servicio Cántabro de Salud, Muriedas, Cantabria, Spain
| | - Carmen Ramos
- Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, Spain
- Camargo Costa - Primary Health Care Center, Servicio Cántabro de Salud, Maliaño, Cantabria, Spain
| | - José M. Olmos
- Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, Spain
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - José L. Hernández
- Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, Spain
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
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