Association between HLA genotype and ferritin levels in COVID-19 infection: a study of a Saudi cohort

Abstract

Background: An elevation in serum ferritin levels through an unknown mechanism was observed in COVID-19 infected patients. This study examined the association between patients’ HLA genotype and serum ferritin level modulation and also assessed the effect of serum ferritin levels on infection severity/mortality. Materials and methods: One hundred and thirty-six COVID-19 Saudi patients were divided into two groups according to their ferritin levels: group 1 (<500 ng/mL, N = 67) and group 2 (>500 ng/mL, N = 69). HLA genotyping (class I and II) was carried out through the rPCR-SSO method. Results: High serum ferritin levels were associated with a significant increase in infection severity, as 75% of ICU patients showed high levels of ferritin compared to 43% of patients with moderate symptoms, p =.002. This elevation indicated a gender skew in that 56% of the infected male patients displayed high ferritin levels compared to 36.6% of the female patients, p =.03. In terms of mortality, 74% of patients with fatal outcomes had a high level of serum ferritin compared to 47% of recovered patients, p =.039. There was a significant difference in the HLA frequency between the two groups, with a predominance of HLA-A*01 in the low-ferritin group (19.4 vs. 6.5%, p =.002, pc =.016) and predominance of C*03 in the high ferritin group (10.9 vs. 3%, p =.047, pc =.27). Conclusion: High serum ferritin levels are associated with an increase in COVID-19 severity, which may be affected by HLA polymorphism.