G6PD deficiency and severity of COVID19 pneumonia and acute respiratory distress syndrome: tip of the iceberg?

Abstract

The severe pneumonia caused by human coronavirus (hCoV)-SARS-CoV-2 has inflicted heavy causalities, especially among the elderly and those with comorbid illnesses irrespective of age. The high mortality in African Americans and males, in general, raises concern for a possible X-linked mediated process that could affect viral pathogenesis and the immune system. We hypothesized that G6PD, the most common X-linked enzyme deficiency associated with redox status, may have a role in the severity of pneumonia. A retrospective chart review was performed in hospitalized patients with COVID19 pneumonia needing supplemental oxygen. A total of 17 patients were evaluated: six with G6PD deficiency and 11 with normal levels. The two groups (normal and G6PD def) were comparable in terms of age, sex and comorbidities and laboratory parameters LDH, IL-6, CRP, and ferritin. Thirteen patients needed ventilatory support, with 6 in the G6PD group (83% vs. 72%). The main differences indicating increasing severity in the G6PD def group included G6PD levels (12.2 vs. 5.6, P=0.0002), PaO2/FiO2 ratio (159 vs. 108, P=0.05), days before intubation (2.5 vs. 4.8 P= 0.03), days on mechanical ventilation (10.25 vs. 21 days P=0.04), hemoglobin level (10 vs. 8.1 P=0.03) and hematocrit (32 vs. 26 P=0.015). Only one patient with G6PD deficiency died; 16 were discharged home. Our clinical series ascribes a possible biological role for G6PD deficiency in SARS-CoV2 viral proliferation. It is imperative that further studies be performed to understand the interplay between the viral and host factors in G6PD deficiency that may lead to disparity in outcomes.

Assessing glucose-6-phosphate dehydrogenase (G6PD) during COVID-19 requires caution: evidence on the impact of the infection upon enzyme activity

“…On the follow-up, the minimum hemoglobin values were also higher in the G6PDd group, in contrast to the maximum direct bilirubin values, which were lower than those presented by the G6PDn group. These findings diverge from previous studies, which have reported a decreased hemoglobin level, increased blood neutrophils and increased bilirubin in G6PDd patients with COVID-19 [37,55,56]. Analyzing a selected subgroup, one year later, we showed that only one-third of those participants previously classified as deficient were correctly classified, suggesting a G6PD activity modulation during the illness.…”

COVID-19: A Catalyst for Novel Psychiatric Paradigms - Part 1

“…Several recent studies have supported this model as they established that G6PD deficient individuals, including many African Americans, are more likely to develop COVID-19 critical illness [6,7,[114][115][116]. Moreover, G6PD deficiency was associated with cardiovascular disease, hypertension, liver fibrosis and iron dyshomeostasis, indicating the importance of redox balance in this pathology [117][118][119][120][121].…”

Glucose-6-phosphate dehydrogenase deficiency presenting with rhabdomyolysis in a patient with coronavirus disease 2019 pneumonia: a case report

“…Clinical observations suggest that G6PD deficiency may worsen outcomes following SARS-CoV-2 infection. Hospitalized patients with G6PD deficiency and COVID-19 pneumonia had lower PaO 2 /FiO 2 ratio, longer duration of mechanical ventilation, and reduced hemoglobin level compared with those with normal G6PD [ 17 ].…”

“…Higher mortality rates have also been observed among African American males admitted for COVID-19 pneumonia [ 18 , 19 ]. Potential explanations for such outcomes include the higher frequency of G6PD deficiency in this population, in addition to socioeconomic factors [ 17 , 20 , 21 ].…”