Demographic, clinical and genetic factors associated with COVID-19 disease susceptibility and mortality in a Kurdish population

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a devastat-ing pandemic that causes disease with a variability in susceptibility and mortality based on variants of various clinical and demographic factors, including particular genes among populations. OBJECTIVES: Determine associations of demographic, clinical, labo-ratory, and single nucleotide polymorphisms in the ACE2, TMPRSS2, TNF-& alpha;, and IFN-& gamma; genes to the incidence of infection and mortality in COVID-19 patients. DESIGN: Prospective cohort study SETTINGS: Various cities in the Kurdistan Region of Iraq. PATIENTS AND METHODS: This prospective cohort study compared laboratory markers (D-dimer, tumor necrosis factor-alpha [TNF-& alpha;], interferon-gamma [IFN-& gamma;], C-reactive protein [CRP], lymphocyte and neutrophil counts) between COVID-19 patients and healthy controls. DNA was extracted from blood, and genotypes were done by Sanger sequencing. MAIN OUTCOME MEASURES: Single nucleotide polymorphisms of the ACE2, TMPRSS2, TNF-& alpha;, and IFN-& gamma; genes and demographic characteristics and laboratory markers for predicting mortality in COVID-19. SAMPLE SIZE: 203 (153 COVID-19 patients, 50 health control sub-jects). RESULTS: Forty-eight (31.4%) of the COVID-19 patients died. Age over 40 and comorbidities were risk factors for mortality, but the stron-gest associations were with serum IFN-& gamma;, the neutrophil-to-lympho-cyte ratio (NLR), and serum TNF-& alpha;. The AA genotype and A allele of TMPRSS2 rs2070788 decreased while the GA genotype and A allele of TNF-& alpha; increased susceptibility to COVID-19. Patients with the GA genotype of TNF-& alpha; rs1800629 had shorter survival times (9.9 days) than those carrying the GG genotype (18.3 days) (P<.0001 by log -rank test). The GA genotype versus the GG genotype was associated with higher levels of serum TNF-& alpha;. The GA genotype increased mor-tality rates by up to 3.8 fold. The survival rate for COVID-19 patients carrying the IFN-& gamma; rs2430561 TT genotype (58.5%) was lower than in patients with the TA and AA genotypes (80.3%). The TT genotype increased the risk of death (HR=3.664, P<.0001) and was linked to high serum IFN-& gamma; production. Olfactory dysfunction was a predictor of survival among COVID-19 patients. CONCLUSIONS: Age older than 40, comorbidities, the NLR and par-ticular genotypes for and the IFN-& gamma; and TNF-& alpha; genes were risk factors for death. Larger studies in different populations must be conducted to validate the possible role of particular SNPs as genetic markers for disease severity and mortality in COVID-19 disease.