The impact of blood type on the mortality of patients with severe abdominal trauma: a multicenter observational study

Impact of ABO blood group on mortality in trauma patients: A systematic review

BACKGROUND

Haemorrhage is a significant cause of death in trauma patients. There is evidence that individuals with blood group O have higher rates of non-traumatic haemorrhage. It has been suggested that blood group O may be associated with higher mortality in trauma, however existing evidence is limited and conflicting.

OBJECTIVE

A systematic review was conducted to evaluate the impact of ABO blood group on mortality in trauma patients.

METHODS

MEDLINE via OVID, the Cochrane library and grey literature were searched to identify studies investigating the effect of ABO blood group on mortality of trauma patients admitted to hospital. PRISMA guidelines were followed throughout, study quality was assessed using CASP checklists and certainty of evidence was evaluated using GRADE. Meta-analysis was precluded by significant study heterogeneity.

RESULTS

180 relevant records were screened and seven studies met inclusion criteria, representing 12,240 patients. Two studies found that there was a higher mortality in blood group O compared to other ABO groups. Included studies had substantial variability in methods and population. Study quality was variable with certainty of evidence rated as very low.

CONCLUSIONS

There is insufficient evidence to definitively establish an association between mortality and ABO group in trauma patients. In an age of increasingly individualised care, there is a need to determine the existence and cause for any association through further studies across multiple settings, trauma mechanisms and populations.

Type-O Blood Is Not Associated With Elevated Mortality After Trauma: A North American Cohort Study

BACKGROUND

Recent studies have presented contradictory findings on the relationship between blood type and mortality in trauma patients. Using the largest population in a study of this type to date, we hypothesized that ABO genotype and Rhesus status would influence trauma-related mortality and morbidity given the relationship between blood type and hemostasis.

METHODS

Data from all trauma patients admitted to level I and level II trauma centers in one city over a five-year period was retrospectively analyzed. Patients were stratified by ABO type. Patient demographics and outcomes were then assessed. Chi-squared and Fisher's exact tests were used to analyze categorical variables. Continuous variables were analyzed using ANOVA or Kruskal-Wallis tests as appropriate. Logistic regression was used to determine independent associations for 28-day mortality and complications.

RESULTS

Of 5249 patients, severe injury (ISS >15) was present in 1469. Approximately one-quarter of patients with severe injury received blood products within the first 24 hours. There were no significant variations in demographics or complications between patients of different blood types. Univariate and multivariable regression analysis showed no association between blood type and mortality. However, penetrating injury, lower GCS, higher ISS, blood transfusion within 24 hours, and Asian descent were associated with higher overall mortality.

CONCLUSIONS

In contrast to previous studies, we found no evidence of an association between blood type and mortality. However, our findings suggest that patients of Asian descent may be at higher risk for mortality following trauma. Further research is warranted to explore this observation.

Impact of COVID status and blood group on complications in patients in hemorrhagic shock

Objective

Among critically injured patients of various blood groups, we sought to compare survival and complication rates between COVID-19-positive and COVID-19-negative cohorts.

Background

SARS-CoV-2 infections have been shown to cause endothelial injury and dysfunctional coagulation. We hypothesized that, among patients with trauma in hemorrhagic shock, COVID-19-positive status would be associated with increased mortality and inpatient complications. As a secondary hypothesis, we suspected group O patients with COVID-19 would experience fewer complications than non-group O patients with COVID-19.

Methods

We evaluated all trauma patients admitted 4/2020-7/2020. Patients 16 years or older were included if they presented in hemorrhagic shock and received emergency release blood products. Patients were dichotomized by COVID-19 testing and then divided by blood groups.

Results

3281 patients with trauma were evaluated, and 417 met criteria for analysis. Seven percent (29) of patients were COVID-19 positive; 388 were COVID-19 negative. COVID-19-positive patients experienced higher complication rates than the COVID-19-negative cohort, including acute kidney injury, pneumonia, sepsis, venous thromboembolism, and systemic inflammatory response syndrome. Univariate analysis by blood groups demonstrated that survival for COVID-19-positive group O patients was similar to that of COVID-19-negative patients (79 vs 78%). However, COVID-19-positive non-group O patients had a significantly lower survival (38%). Controlling for age, sex and Injury Severity Score, COVID-19-positive patients had a greater than 70% decreased odds of survival (OR 0.28, 95% CI 0.09 to 0.81; p=0.019).

Conclusions

COVID-19 status is associated with increased major complications and 70% decreased odds of survival in this group of patients with trauma. However, among patients with COVID-19, blood group O was associated with twofold increased survival over other blood groups. This survival rate was similar to that of patients without COVID-19.

Group B or not group B? An association between ABO, early mortality, and organ dysfunction in major trauma patients with shock

BACKGROUND

ABO blood group alters coagulation profiles in the general population and may influence outcomes after trauma. The relationship between trauma-induced coagulopathy, severe injury with hemorrhagic shock, and survival with respect to ABO group is unknown.

OBJECTIVES

In severe hemorrhagic trauma, we aimed to characterize the association of ABO group with admission coagulation profiles, mortality, and immune-mediated complications.

METHODS

Clinical and laboratory variables were examined from severely injured adult patients enrolled in a perpetual observational cohort study at a UK Major Trauma Center. Univariate and multivariate analyses were performed to determine differences in clinical outcomes (mortality, organ dysfunction, and critical care support). In a shock subgroup, we performed an exploratory analysis of rotational thromboelastometry parameters and coagulation biomarkers.

RESULTS

In 1119 trauma patients, we found no difference in mortality between ABO groups. In patients with shock, 24-hour mortality was significantly lower in group B vs non-B groups (7% vs 16%, adjusted odds ratio [aOR], 0.19; P = .030), but there were increased rates of invasive ventilation (aOR, 3.34; P = .033), renal replacement therapy (aOR, 2.55; P = .037), and a trend for infection (aOR, 1.85; P = .067). Comparing patients with shock, group B vs non-B patients had 40% higher fibrinogen, 65% higher factor (F) VIII, 36% higher FIX, 20% higher FXIII, and 19% higher von Willebrand factor.

CONCLUSION

In this observational study limited by single time-point sampling and subgroup analysis of trauma hemorrhage with shock, group B patients have enhanced hemostatic capability associated with early survival but with increased risk of immune-mediated complications.

ABO blood group and cochlear function: evidence from a large sample size study

OBJECTIVE

The present study investigated the effect of blood group on cochlear function in a large participant sample across different age groups. The study hypothesis was that participants with blood group O would show relatively reduced cochlear function as reflected in otoacoustic emission (OAE) measures.

DESIGN

Data were collected from transient evoked otoacoustic emission (TEOAE), distortion product otoacoustic emission (DPOAE), DPOAE input/output (I/O) function, and spontaneous otoacoustic emission (SOAE) recordings.

STUDY SAMPLE

Four hundred and sixty-three normal hearing adults aged 20-59 years among the four ABO blood groups participated in the study.

RESULTS

TEOAE and DPOAE amplitudes did not reveal significant differences for participants with blood group O compared with participants with non-O blood groups. No significant differences in I/O function categories were found among participants with different blood groups. SOAE prevalence was also not significantly different across blood groups. However, previously reported age and gender differences for OAE variables were confirmed.

CONCLUSIONS

Participants with blood group O were not found to have significantly reduced cochlear function, based on OAE measures. Results from the current study do not support the hypothesis that normal hearing individuals with different ABO blood groups differ in level of cochlear function.

Mortality and outcomes by blood group in trauma patients: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

Blood group O contains lower levels of factor VIII and von Willebrand factor. Higher incidence of bleeding among group O is reported in multiple contexts. Results of studies vary regarding outcomes stratified by blood group in trauma. We systematically reviewed the literature for outcomes related to blood group in trauma patients. Meta-analysis of studies evaluating mortality related to blood group was performed.

MATERIALS AND METHODS

The PubMed and Embase databases were searched for studies analysing relationships between blood group and outcomes in trauma patients. Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. We synthesized outcomes data related to blood group. Meta-analysis compared mortality rates between group O and non-O patients.

RESULTS

Inclusion criteria were met by 13 studies. Statistically significant differences by blood group were reported in 3 of 10 (30%) studies evaluating mortality, 2 of 3 (66.7%) evaluating mortality from haemorrhage and 2 of 9 (22.2%) evaluating transfusion requirement. Meta-analysis was performed on seven studies evaluating mortality (total n = 11,835). There was significant heterogeneity among studies (I²  = 86%, p < 0.00001). No difference was found in mortality between group O and non-O patients (relative risk = 1.21, 95% confidence interval = 0.89-1.64, p = 0.23).

CONCLUSION

Existing literature does not consistently demonstrate a mortality difference between trauma patients with O and non-O blood groups. High variability in the methods and results among studies limits this conclusion, and further research is needed to delineate under what circumstances blood group may influence outcomes.

Is Low-Titer Group O Whole Blood Truly a Universal Blood Product?

BACKGROUND

Whole blood was historically transfused as a type-specific product. Given recent advocacy for low-titer group O whole blood (LTOWB) as a universal blood product, we examined outcomes after LTOWB transfusion stratified by recipient blood groups.

STUDY DESIGN

Adult trauma patients receiving prehospital or in-hospital transfusion of LTOWB (November 2017 to July 2020) at a single trauma center were prospectively evaluated. The patients were divided into blood type groups (O, A, B, and AB). Major complications and survival to 30 days were compared. Univariate analyses among blood groups were followed by purposeful regression modeling, reflecting 6 variables of significance: male sex, White race, injury severity, arrival lactate, arrival systolic blood pressure, and emergency department blood products.

RESULTS

Of 1,075 patients receiving any LTOWB, 539 (50.1%) were Group O, 340 (31.6%) were Group A, 150 (14.0%) were Group B, and 46 (4.3%) were Group AB. There were no statistically significant differences in demographics, injury severity, hemolysis panels, prehospital vitals, or resuscitation parameters (all p > 0.05). However, arrival systolic pressure was lower (91 vs 102, p = 0.034) and lactate was worse (5.5 vs 4.1, p = 0.048) in Group B patients compared to other groups. While survival and most major complications did not differ across recipient groups, acute kidney injury (AKI) initially appeared higher for Group B. Stepwise regression did not show a difference in AKI rates. This analysis was repeated in patients receiving only component products. Group B again showed no significantly increased risk of AKI (13%) compared to other groups (O 7%, A 7%, AB 5%; p = 0.091).

CONCLUSIONS

LTOWB appears to be a safe product for universal use across all blood groups. Group B recipients arrived with worse physiologic values associated with hemorrhagic shock whether receiving LTOWB or standard component products.

BLOOD TYPE O IS A RISK FACTOR FOR HYPERFIBRINOLYSIS AND MASSIVE TRANSFUSION AFTER SEVERE INJURY

ABSTRACT

Background: Blood type O is the most common blood type and has lower von Willebrand factor (vWF) levels (25%-35% lower than non-O blood types). von Willebrand factor is important for initiating platelet attachment and binding factor VIII. We hypothesized that patients with type O blood are at an increased risk of trauma-induced coagulopathy and bleeding post injury. Study Design: Adult trauma activations with known blood type at a level I trauma center with field systolic blood pressure < 90 mm Hg were studied retrospectively. The relationships of blood group O versus non-O to coagulation assays, massive transfusion (MT), ventilator-free days, and mortality were adjusted for confounders. Hyperfibrinolysis (HF) was defined as thromboelastogram of percent lysis in 30 min > 3%, and fibrinolysis shutdown was defined as percent lysis in 30 min < 0.9%. von Willebrand factor activity was quantified on 212 injured patients using a STAGO apparatus. Results: Overall, 268 patients met criteria. Type O patients were more likely to develop HF than non-type O blood patients (43% vs. 29%, P = 0.06) and had significantly lower vWF activity (222% vs. 249%, P = 0.01). After adjustment for New Injury Severity Score and blunt mechanism, type O had higher odds of HF (odds ratio, 1.94, 95% confidence interval, 1.09-3.47) and increased odds of MT (odds ratio, 3.02; 95% confidence interval, 1.22-7.49). Other outcomes were not significantly affected. Conclusion: Type O patients with hypotension had increased HF and MT post injury, and these were associated with lower vWF activity. These findings have implications for the monitoring of HF in patients receiving type O whole-blood transfusions post injury.

Clinical characteristics and hematological parameters associated with disease severity in COVID-19 positive pregnant women undergoing cesarean section: A single-center experience

AIM

The study aimed to describe clinical characteristics and outcomes of pregnant women with COVID-19 undergoing cesarean section, and evaluated the association of blood values at admission with severe COVID-19 disease in this group of patients.

METHOD

We retrospectively analyzed the clinical data of 110 patients infected with COVID-19 who underwent cesarean section at Adana City Education and Research Hospital in Turkey. The COVID-19 severity of the patients was classified as either severe or nonsevere disease according to World Health Organization of COVID-19 clinical management guidance. We compared blood values, clinical characteristics, and outcomes between severe and nonsevere patients. Receiver operating characteristics (ROC) curves analyses and area under the ROC curve (AUC) value was calculated to evaluate the predictive value of blood parameters on the COVID-19 severity.

RESULTS

Of the 110 women, 12 were severe cases. Severe patients had higher ferritin, neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase (LDH), alanine transaminase (ALT), aspartate transaminase (AST), and procalcitonin levels on admission (p < 0.05). The ROC analysis demonstrated AUC of NLR, LDH, AST, ALT, ferritin, and procalcitonin was 0.757, 0.856, 0.840, 0.771, 0.821, and 0.698, respectively. The LDH had a maximum specificity (90.8%), with the cutoff value of 365. The O-blood group was more likely to have severe illness than the non-O-blood group (relative risk: 3.6; 95% confidence interval; 1.2-10.4).

CONCLUSION

This study shows that LDH values at admission are an early and powerful predictor of severe infection for pregnant women with COVID-19 who will undergo a cesarean section.