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Fabyan Esberard de Lima Beltrão Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
University Center of João Pessoa – UNIPE, João Pessoa, PB, Brazil

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Daniele Carvalhal de Almeida Beltrão University Center of João Pessoa – UNIPE, João Pessoa, PB, Brazil
Post-Graduation Program in Cognitive Neuroscience and Behavior, Psychology Department of the Center of Human Sciences, Federal University of Paraíba, João Pessoa, Paraíba, Brazil

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Giulia Carvalhal Center for Biological and Health Sciences, Federal University of Campina Grande, Campina Grande, Paraíba, Brazil

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Fabyanna Lethicia de Lima Beltrão Post-Graduate Program in Medicine and Health, Medical School of Medicine, Federal University of Bahia, Salvador, Brazil

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Jocyel de Brito Oliveira Bioregulation Department, Health and Science Institut, Federal University of Bahia, Salvador, Bahia, Brazil

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Hatilla dos Santos Silva Bioregulation Department, Health and Science Institut, Federal University of Bahia, Salvador, Bahia, Brazil

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Helena Mariana Pitangueira Teixeira Bioregulation Department, Health and Science Institut, Federal University of Bahia, Salvador, Bahia, Brazil

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Juliana Lopes Rodrigues Laboratory of Immunopharmacology and Molecular Biology, Health Sciences Institute, Federal University of Bahia, Brazil

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Camila Alexandrina Viana de Figueiredo Laboratory of Immunopharmacology and Molecular Biology, Health Sciences Institute, Federal University of Bahia, Brazil

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Ryan dos Santos Costa Laboratory of Immunopharmacology and Molecular Biology, Health Sciences Institute, Federal University of Bahia, Brazil

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Fabio Hecht The Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

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Giciane Carvalho Vieira Post-Graduation Program in Cognitive Neuroscience and Behavior, Psychology Department of the Center of Human Sciences, Federal University of Paraíba, João Pessoa, Paraíba, Brazil

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Maria da Conceição Rodrigues Gonçalves Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil

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Antonio C. Bianco Section of Endocrinology and Metabolism, Division of the Biological Sciences, University of Chicago, Chicago, Illinois, USA

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Helton Estrela Ramos Post-Graduate Program in Medicine and Health, Medical School of Medicine, Federal University of Bahia, Salvador, Brazil
Postgraduate Program in Interactive Processes of Organs and Systems, Health & Science Institute, Federal University of Bahia, Salvador, BA, Brazil

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Introduction

The type 2 deiodinase and its Thr92Ala-DIO2 polymorphism have been linked to clinical outcomes in acute lung injury and coronavirus disease 2019 (COVID-19).

Objective

The objective was to identify a potential association between Thr92Ala-DIO2 polymorphism and body composition (appendicular muscle mass, myosteatosis, and fat distribution) and to determine whether they reflect the severity or mortality associated with the disease.

Methods

In this prospective cohort study (June–August 2020), 181 patients hospitalized with moderate-to-severe COVID-19 underwent a non-contrast-enhanced computed tomography (CT) of the thorax to assess body composition, laboratory tests, and genotyping for the Thr92Ala-DIO2 polymorphism.

Results

In total, 181 consecutive patients were stratified into three subgroups according to the genotype: Thr/Thr (n = 64), Thr/Ala (n = 96), and Ala/Ala (n = 21). The prevalence of low muscle area (MA) (< 92 cm²) was 52.5%. Low MA was less frequent in Ala/Thr patients (44.8%) than in Thr/Thr (60.9%) or Ala/Ala patients (61.9%) (P = 0.027). Multivariate logistic regression analysis confirmed that the Thr/Ala allele was associated with a reduced risk of low MA (41% to 69%) and myosteatosis (62% to 72%) compared with Thr/Thr + Ala/Ala (overdominant model). Kaplan–Meier curves showed that patients with low muscle mass and homozygosity had lower survival rates than the other groups. Notably, the heterozygotes with MA ≥92 cm² exhibited the best survival rate.

Conclusion

Thr92Ala-DIO2 heterozygosity is associated with increased skeletal MA and less myosteatosis in patients with COVID-19. The protective effect of Thr92Ala-DIO2 heterozygosity on COVID-19 mortality is restricted to patients with reduced MA.

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