Sickle cell trait linked with higher risk of COVID-19 death in those of African ancestry
Click Here to Manage Email Alerts
Among patients with African ancestry, those with sickle cell trait are at a higher risk for COVID-19–related death, according to data published in JAMA Internal Medicine.
Further, investigators found sickle cell trait (SCT) correlated with preexisting kidney comorbidities, increased COVID-19 mortality and kidney morbidity
“SCT affects more than 3 million people in the U.S. and 300 million people globally, but because it is not routinely assessed, there is a paucity of data on the association between SCT and COVID-19 outcomes,” Anurag Verma, PhD, from Corporal Michael J. Crescenz Veterans Affairs Medical Center in Philadelphia, Pennsylvania, and colleagues wrote.
In a genetic associations study, researchers examined information for 132,577 patients (mean age at index date was 64.8 years) with available COVID-19 data within the Million Veteran Program (MVP) within the Department of Veterans Affairs (VA). Researchers sought to determine the correlation of SCT with preexisting conditions, COVID-19 outcome severity and post–COVID-19 conditions. Primary outcomes included susceptibility, hospitalization, severe conditions of which patients required ventilator support or intensive care, and death due to COVID-19.
All COVID-19 and kidney function data were derived from the electronic health record data collected at a VA medical center until March 2021.
Researchers identified and used directly genotyped (rs334-T) or imputed (rs33930165-T) markers in the hemoglobin beta gene for association testing.
Using firth regression, researchers measured the association between SCT and COVID-19 outcomes. Additionally, researchers conducted analyses by patients’ ancestry and adjusted for sex, age, age squared and ancestral principal components to account for population stratification.
COVID-19 clinical data include 2,729 patients with SCT. Of these patients, 353 had COVID-19. Of the 129, 848 SCT-negative patients, 13,488 had COVID-19.
Researchers observed SCT was present in 7.8% of veterans of African ancestry and correlated with a history of chronic kidney disease, diabetic kidney disease, hypertensive kidney disease, pulmonary embolism and cerebrovascular disease. Similarly, SCT was associated with an increased COVID-19 mortality in patients of African ancestry.
During the 60-day follow-up after COVID-19, researchers found SCT correlated with an increased incidence of acute kidney failure.
A counterfactual mediation framework revealed that, on average, 20.7% of the total impact of SCT on COVID-19 mortalities was a result of acute kidney failure.
“Our findings suggest that SCT can further contribute to worse outcomes in individuals of African ancestry, and there is a need for new treatment strategies to improve clinical outcomes of COVID-19 in individuals with SCT,” Verma and colleagues wrote. “The presence of an HbC allele was not associated with worse COVID-19 outcomes. The lack of associations of HbC with multiple medical/kidney comorbidities may explain the difference in COVID-19 outcomes.”
Collapse
Read more about
Click Here to Manage Email Alerts