Association of Prothrombin G20210A (Factor II) and PAI-1 4G/5G polymorphisms with COVID-19 infection in emergency department patients

Purpose: This study aimed to investigate whether Prothrombin G20210A (Factor II) and PAI-1 4G/5G gene polymorphisms are associated with COVID-19 severity and clinical outcomes among patients admitted to the Emergency Department of Pamukkale University Hospital (Denizli, Türkiye) between June and December 2021.Materials and methods: In this prospective, cross-sectional, observational study, 150 PCR-confirmed COVID-19 patients and 300 healthy volunteers were genotyped for Prothrombin G20210A and PAI-1 4G/5G polymorphisms by PCR and DNA sequencing. Laboratory parameters, disease severity indices, intensive care unit (ICU) admission, and mortality were analyzed.Results: The genotype distribution among patients was GA 54.7% and GG 45.3% for Prothrombin G20210A, and 4G/4G 77.3% and 4G/5G 22.7% for PAI-1. There were no significant differences in Prothrombin G20210A variants except for lower lymphocyte counts in GA carriers (p=0.031). The PAI-1 4G/5G group showed a significantly higher monocyte count (p=0.012), while differences in urea and other biochemical parameters were not statistically significant (p>0.05). Patients carrying both PAI-1 and Prothrombin heterozygous variants (double heterozygotes, n=13) had lower hemoglobin (p=0.010) and lymphocyte counts (p=0.012), but higher monocyte (p=0.001) and ferritin levels (p=0.006). This subgroup also demonstrated lower oxygen saturation (p=0.049) and significantly higher intensive care unit admission (46.2% vs. 15.3%, p=0.005) and mortality (38.5% vs. 9.5%, p=0.002).Conclusion: Prothrombin G20210A and PAI-1 4G/5G polymorphisms particularly their coexistence were associated with hematologic and inflammatory alterations, as well as increased ICU admission and mortality rates. These variants may have potential value for risk stratification and should be evaluated in larger studies.