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Investigating the Impact of Host Genetics on the Risk of Disease Progression in Individuals With Influenza

Sara Bohnstedt Mørup, Maja Milojevic*, Seyed Mahmood Taghavi Shahri, Brad T. Sherman, Weizhong Chang, Ruth Lynfield, Marie Helleberg, Melissa Skeans, Lars Østergaard, Line Borgwardt, Norman Gerry, Marcelo Losso, Kenneth Baillie, Richard Davey, Dominic E. Dwyer, Chansavath Phetsouphanh, Vasileios Papastamopoulos, Richard M. Novak, Daniel D. Murray, Joanne ReekieJens D. Lundgren, H. Clifford Lane, Cavan Reilly, For the INSIGHT FLU 002 Plus and FLU 003 Plus Study Groups

*Corresponding author for this work

Abstract

Background: Knowledge of the human genetic contribution to the risk of complications from influenza is limited. This study assessed the association between human single-nucleotide polymorphisms (SNPs) and disease progression in individuals with influenza. Methods: A targeted analysis of 10 SNPs with prior evidence in COVID-19 and a genome-wide association study (GWAS) were used to assess associations between SNPs and disease progression in two multinational cohorts with suspected or laboratory-confirmed influenza: a hospitalized cohort (n = 1634) and a pooled cohort of hospitalized and outpatients (n = 3469). Disease progression was defined as prolonged hospitalization (> 28 days), progression to mechanical ventilation, admittance to intensive care unit, or death (for hospitalized individuals) or progression to hospitalization or death (for outpatients). Results: Disease progression was observed in 9.1% of hospitalized patients and 2.2% of outpatients. Age was a significant risk factor for disease progression, with 20% increased odds of disease progression per 10-year increase in age (OR: 1.20, 95%CI: 1.08–1.33, p < 0.001). Disease progression rates also differed by continent (p < 0.0001). Targeted SNP analyses did not identify significant associations with disease progression; however, the strength of associations was most pronounced in sensitivity analyses for the pooled cohort in individuals < 65 years old. GWAS analyses did not identify significant common SNP associations in either the hospitalized or pooled cohorts, nor in sensitivity analysis of (1) individuals with laboratory-confirmed influenza and (2) those aged < 65 years. Conclusion: In a geographically diverse cohort of individuals with influenza, the genetic links to disease progression only started to become evident in the sensitivity analyses, mainly when looking at younger individuals. The power to detect associations was limited by the rate of disease progression and heterogeneity in phenotypes of the individuals studied, and therefore, additional studies focused on the role of genetics in influenza disease progression are needed.

Original languageEnglish
Article numbere70394
JournalImmunity, Inflammation and Disease
Volume14
Issue number3
ISSN2050-4527
DOIs
Publication statusPublished - Mar 2026

Keywords

  • GWAS
  • host genetics
  • severe influenza
  • SNP-microarray
  • targeted analyses

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