Low Prevalence of Mild Alpha-1-Antitrypsin Deficiency in Hospitalized COVID-19-Patients

David Nygren; Ulrica Mölstad; Hans Thulesius; Magnus Hillman; Lars Mikael Broman; Hanan Tanash; Mona Landin-Olsson; Magnus Rasmussen; Maria Thunander

doi:10.2147/IJGM.S370434

Low Prevalence of Mild Alpha-1-Antitrypsin Deficiency in Hospitalized COVID-19-Patients

Int J Gen Med. 2022 Jun 28:15:5843-5848. doi: 10.2147/IJGM.S370434. eCollection 2022.

Authors

David Nygren¹, Ulrica Mölstad², Hans Thulesius^{2

3

4}, Magnus Hillman^{5

6}, Lars Mikael Broman^{7

8}, Hanan Tanash^{9

10}, Mona Landin-Olsson^{5

6}, Magnus Rasmussen¹, Maria Thunander^{2

6

11}

Affiliations

¹ Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.
² Department of Research and Development, Health Care Region Kronoberg, Växjö, Sweden.
³ Department of Medicine and Optometry, Linnaeus University, Växjö, Sweden.
⁴ Department of Clinical Sciences, Family Medicine, Lund University, Malmö, Sweden.
⁵ Diabetes Research Laboratory, Biomedical Center, Lund University, Lund, Sweden.
⁶ Department of Clinical Sciences, Endocrinology and Diabetes, Lund University, Lund, Sweden.
⁷ ECMO Centre Karolinska, Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
⁸ Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
⁹ Department of Clinical Sciences, Respiratory Medicine, Lund University, Malmö, Sweden.
¹⁰ Department of Respiratory Medicine, Skåne University Hospital, Malmö, Sweden.
¹¹ Department of Internal Medicine, Endocrinology, Växjö Central Hospital, Växjö, Sweden.

Abstract

Introduction: Alpha-1-antitrypsin (AAT) has been shown to inhibit SARS-CoV-2 cell entry and suggested as a therapeutic agent for COVID-19. Furthermore, epidemiological association of high prevalence of Alpha-1-antitrypsin deficiency (AATD) and regional severity of COVID-19-impact has been hypothesized. In our study setting, the estimated prevalence rates of mild (PI*MZ, PI*SS or PI*MS) and moderate-to-severe AATD (PI*ZZ or PI*SZ) are high, 9% and 0.2%, respectively. Our primary aim was to examine the prevalence rate of AATD among hospitalized COVID-19-patients.

Methods: In this prospective observational study, enrollment occurred from December 2020 to January 2021 in two COVID-19-units at Skåne University Hospital, Lund, Sweden. Case definition was a patient hospitalized due to COVID-19. Patients were screened for AATD with PI-typing and if results were inconclusive, PCR for the S- and Z-genes were performed. Patients were categorized as severe or moderate COVID-19 and 30-day-mortality data were collected. The primary outcome was prevalence rate of AATD. The secondary outcome investigated association between presence of mild AATD and severe COVID-19.

Results: We enrolled 61 patients with COVID-19. Two patients out of 61 (3%) had mild AATD (PI*MZ) and none had moderate-to-severe AATD. 30/61 (49%) had severe COVID-19. Both patients with mild AATD developed severe COVID-19. Yet, presence of AATD was not significantly associated with severe COVID-19 (p=0.24).

Conclusion: Mild AATD (PI*MS or PI*MZ) was rare in a small cohort of hospitalized patients with COVID-19 in a study setting with a high background prevalence of AATD.

Keywords: COVID-19; PI-typing; SARS-CoV-2; SERPINA1; alpha-1-antitrypsin; alpha-1-antitrypsin deficiency.

Grants and funding

The authors of the study report funding from the Swedish Heart Lung Foundation, the Swedish Physicians’ Research Society and Swedish Government Funds for Clinical Research (ALF).