Impact of ABO and Rhesus blood groups on COVID-19 susceptibility and severity: A case-control study

ABO blood group and rhesus factor association with inpatient COVID-19 mortality and severity: a two-year retrospective review

Background

Early reports have indicated a relationship between ABO and rhesus blood group types and infection with SARS-CoV-2. We aim to examine blood group type associations with COVID-19 mortality and disease severity.

Methods

This is a retrospective chart review of patients ages 18 years or older admitted to the hospital with COVID-19 between January 2020 and December 2021. The primary outcome was COVID-19 mortality with respect to ABO blood group type. The secondary outcomes were 1. Severity of COVID-19 with respect to ABO blood group type, and 2. Rhesus factor association with COVID-19 mortality and disease severity. Disease severity was defined by degree of supplemental oxygen requirements (ambient air, low-flow, high-flow, non-invasive mechanical ventilation, and invasive mechanical ventilation).

Results

The blood type was collected on 596 patients with more than half (54%, N=322) being O+. The ABO blood type alone was not statistically associated with mortality (P=0.405), while the RH blood type was statistically associated with mortality (P<0.001). There was statistically significant association between combined ABO and RH blood type and mortality (P=0.014). Out of the mortality group, the O+ group had the highest mortality (52.3%), followed by A+ (22.8%). The combined ABO and RH blood type was statistically significantly associated with degree of supplemental oxygen requirements (P=0.005). The Kaplan-Meier curve demonstrated that Rh- patients had increased mortality.

Conclusion

ABO blood type is not associated with COVID-19 severity and mortality. Rhesus factor status is associated with COVID-19 severity and mortality. Rhesus negative patients were associated with increased mortality risk.

Stenotrophomonas maltophilia pneumonia in critical COVID-19 patients

Stenotrophomonas maltophilia, an environmental aerobic non-fermentative Gram-negative bacilli, has gained attention in many nosocomial outbreaks. COVID-19 patients in intensive care unit have extended hospital stay and are severely immunosuppressed. This study aimed to determine the prevalence and risk factors of S. maltophilia pneumonia in critical COVID-19 patients. A total of 123 COVID-19 patients in ICU admitted between March 2020 and March 2021 were identified from the authors' institutional database and assessed for nosocomial pneumonia. Demographic data and factors predisposing to S. maltophilia pneumonia were collected and analyzed. The mean age was 66 ± 13 years and 74% were males. Median APACHE and SOFA scores were 13 (IQR = 8-19) and 4 (3-6), respectively. The Median NEWS2 score was 6 (Q1 = 5; Q3 = 8). The Median ICU stay was 12 (Q1 = 7; Q3 = 22) days. S. maltophilia was found in 16.3% of pneumonia patients, leading to a lengthier hospital stay (34 vs. 20 days; p < 0.001). Risk factors for S. maltophilia pneumonia included previous treatment with meropenem (p < 0.01), thrombopenia (p = 0.034), endotracheal intubation (p < 0.001), foley catheter (p = 0.009) and central venous catheter insertion (p = 0.016). S. maltophilia nosocomial pneumonia is frequent in critical COVID-19 patients. Many significant risk factors should be addressed to reduce its prevalence and negative impact on outcomes.

Sex and ABO Blood Differences in SARS-CoV-2 Infection Susceptibility

Data consisting of millions of cases cannot still explain the immunopathogenesis mechanism between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and host cell for ongoing coronavirus disease 2019 (COVID-19) pandemics. Epidemiological studies among different populations suggested different impacts of ABO and Rh antibodies on the COVID-19 susceptibility. Thus, the ABO blood group and the SARS-CoV-2 infection paradox remain unclear. Therefore, the present retrospective case-control study aimed to investigate the possible association between ABO blood groups and Rh blood types on SARS-CoV-2 infection in the Turkish Cypriot population. A total of 18,639 Turkish Cypriot subjects (297 SARS-CoV-2 COVID-19 patients and 18,342 healthy) were included in this study. Personal and clinical characteristics including age, gender, SARS-CoV-2 infection status, the ABO blood group and Rh blood types were evaluated and compared between two groups. As a result, ABO blood group was shown to be associated with a higher risk of SARS-CoV-2 infection as well as with male sex ( p  = 0.018). There was no association between Rh blood type and COVID-19. Overall, this study is the first largest sample group study to show the distribution of ABO blood group and Rh blood types in the healthy Turkish Cypriot population. Based on the current evidence, there are insufficient data to guide public health policies regarding COVID-19 pathogenesis.

A large cohort study of the effects of Lewis, ABO, 13 other blood groups, and secretor status on COVID-19 susceptibility, severity, and long COVID-19

BACKGROUND

Previous studies have reported Blood type O to confer a lower risk of SARS-CoV-2 infection, while secretor status and other blood groups have been suspected to have a similar effect as well.

STUDY DESIGN AND METHODS

To determine whether any other blood groups influence testing positive for SARS-CoV-2, COVID-19 severity, or prolonged COVID-19, we used a large cohort of 650,156 Danish blood donors with varying available data for secretor status and blood groups ABO, Rh, Colton, Duffy, Diego, Dombrock, Kell, Kidd, Knops, Lewis, Lutheran, MNS, P1PK, Vel, and Yt. Of these, 36,068 tested positive for SARS-CoV-2 whereas 614,088 tested negative between 2020-02-17 and 2021-08-04. Associations between infection and blood groups were assessed using logistic regression models with sex and age as covariates.

RESULTS

The Lewis blood group antigen Le^a displayed strongly reduced SARS-CoV-2 susceptibility OR 0.85 CI[0.79-0.93] p < .001. Compared to blood type O, the blood types B, A, and AB were found more susceptible toward infection with ORs 1.1 CI[1.06-1.14] p < .001, 1.17 CI[1.14-1.2] p < .001, and 1.2 CI[1.14-1.26] p < .001, respectively. No susceptibility associations were found for the other 13 blood groups investigated. There was no association between any blood groups and COVID-19 hospitalization or long COVID-19. No secretor status associations were found.

DISCUSSION

This study uncovers a new association to reduced SARS-CoV-2 susceptibility for Lewis type Le^a and confirms the previous link to blood group O. The new association to Le^a could be explained by a link between mucosal microbiome and SARS-CoV-2.

Risk Markers of COVID-19, a Study from South-Lebanon

Background: COVID-19, caused by the novel coronavirus SARS-CoV-2, was declared by WHO in early 2020 as a worldwide pandemic. Several known risk markers are associated with COVID-19 morbidity and mortality, including age, gender, and diseases, such as hypertension, diabetes, and chronic cardiovascular diseases. Recent studies have shown an association between COVID-19 infection and the ABO blood groups. Objective: To assess the prevalence of SARS-CoV-2 among suspected COVID-19 patients as well as the risk markers for COVID-19 associated with ABO blood group, Rhesus factor, and patient’s address during the past year. Methods: 69,019 nasopharyngeal swab samples were collected and analyzed by reverse transcription polymerase chain reaction technique for the detection of SARS-CoV-2 in patients attending a tertiary health care center in South Lebanon during the period between August 2020 and July 2021. Results: Among all tested subjects, the prevalence of SARS-CoV-2 infection was 19.2% (95% CI: 18.9% to 19.5%). Among those with known blood group (N = 17,462), odds of SARS-CoV-2 were higher in group A (Odds Ratio = 1.12, 95% CI: 1.02 to 1.23) and group AB (OR = 1.19, 95% CI: 1.00 to 1.41) relative to the reference group O (OR = 1). Odds of SARS-CoV-2 in the Rh-negative group (OR = 1.02, 95% CI: 0.89 to 1.16) were not significantly different from the Rh-positive group. Among those with known address (N = 30,060), odds of SARS-CoV-2 were lower in residents of remote areas (OR = 0.89, 95% CI: 0.80 to 0.99) relative to central cities. Conclusion: There is a modestly higher risk of SARS-CoV-2 infection associated with blood groups A and AB, and a lower risk associated with living in remote, less crowded regions.