Testing the association between blood type and COVID-19 infection, intubation, and death

Relationship between blood group (ABO) and risk of COVID-19 infection in a patient cohort in Tehran, Iran

Background and purpose. Coronavirus (COVID-19) is a contagious disease causing severe acute respiratory syndrome which had a catastrophic effect on the world population and resulted in more than 2.9 million deaths worldwide. Epidemiological investigations have recently announced blood type has an association with the incidence of COVID-19 infection. Consequently, research in this regard can be effective in determining a person's susceptibility to a viral infection. Therefore, we investigated the relationship between blood types and the risk of COVID-19 in patients admitted to Khorshid laboratory, Tehran, Iran. Materials and methods. From January to March 2020, 50 nasal and throat swapb samples of patients' secretions were obtained from patients who were admitted to Khorshid laboratory. They were confirmed to have COVID-19 virus RNA and real-time polymerase chain reaction (PCR)-ABI, and their blood type was determined simultaneously. After collecting data to determine the relationship between COVID-19 infection and blood type, a confidence interval of 90 % was considered using SPSS 16. Results. The mean age of the patients was measured at 38.4±6.3 years. According to PCR results, 100 % of the subjects with COVID-19 showed blood type A. In addition, the ratio of blood type A to the percentage of reference type O was higher (P=0.009). Conclusion. There was a significant relationship between ABO blood type and susceptibility to COVID-19. As the current study suggests, those with blood type A are at a higher COVID-19 infection risk than those with blood type O.

Association of ABO and Rhesus blood groups with severe outcomes from non-SARS-CoV-2 respiratory infection: A prospective observational cohort study in Bristol, UK 2020-2022

Despite significant global morbidity associated with respiratory infection, there is a paucity of data examining the association between severity of non-SARS-CoV-2 respiratory infection and blood group. We analysed a prospective cohort of adults hospitalised in Bristol, UK, from 1 August 2020 to 31 July 2022, including patients with acute respiratory infection (pneumonia [n = 1934] and non-pneumonic lower respiratory tract infection [NP-LRTI] [n = 1184]), a negative SARS-CoV-2 test and known blood group status. The likelihood of cardiovascular complication, survival and hospital admission length was assessed using regression models with group O and RhD-negative status as reference groups. Group A and RhD-positive were over-represented in both pneumonia and NP-LRTI compared to a first-time donor population (p < 0.05 in all); contrastingly, group O was under-represented. ABO group did not influence cardiovascular complication risk; however, RhD-positive patients with pneumonia had a reduced odds ratio (OR) for cardiovascular complications (OR = 0.77 [95% CI = 0.59-0.98]). Compared to group O, group A individuals with NP-LRTI were more likely to be discharged within 60 days (hazard ratio [HR] = 1.17 [95% CI = 1.03-1.33]), while group B with pneumonia was less likely (HR = 0.8 [95% CI = 0.66-0.96]). This analysis provides some evidence that blood group status may influence clinical outcome following respiratory infection, with group A having increased risk of hospitalisation and RhD-positive patients having reduced cardiovascular complications.

Association Between Blood Groups and COVID-19 CT Severity: A Retrospective Analysis From a Tertiary Care Center

INTRODUCTION

The COVID-19 infection can have varied severity; presenting symptoms include fever, coughing, headaches, sore throats, exhaustion, muscle aches, loss of taste or smell, rhinorrhea, stomach pain, diarrhea, and vomiting. In various parts of the world, including India, researchers have looked into the relationship between blood type and the severity of SARS-CoV-2 infection. The aim of the study is to investigate the relationship between COVID-19 infection severity and blood group.

METHODOLOGY

A total of 1,222 COVID-19 patients with real-time reverse transcription-polymerase chain reaction (RT-PCR) confirmation of being COVID-positive were included in the study. Mortality rates, demographic information, comorbid illnesses, epidemiological information, laboratory test results, and comorbid disorders were all retrieved. Each participant's RH type and Groups A, B, O, and AB were determined. IBM SPSS software version 26 (IBM Corp., Armonk, NY) was used for the statistical analysis. For a normal distribution, quantitative variables were shown as mean standard deviation (SD), and for a non-normal distribution, median (interquartile range (IQR)). Frequency and percentages were used to present qualitative characteristics.

RESULTS

Out of the 1,222 patients included in the study, 369 were normal, 406 were mild, 317 were moderate, and 130 were severe based on COVID-19 CT severity scoring. Among the blood groups, O positive (+) was the most common with 503 (41.2%) study participants, and AB negative (-) was the least common with seven (0.6%) participants.

DISCUSSION

In our study, comparing various blood groups, blood group O individuals have the highest risk of developing severe COVID-19 illness, and blood group AB individuals have a reduced risk. In terms of Rh status, patients who are Rh-positive are at increased risk of developing severe COVID-19 infection when compared with Rh- individuals. In the Indian population, blood group O is the commonest, and blood group AB is the least prevalent. Most of the individuals were Rh+, and the rest were Rh-. This is attributed to the increased infection rate in individuals with O+ blood type seen in our study when compared with other studies.

CONCLUSION

The findings indicated that individuals with blood groups A, B, and AB may be at a higher risk of severe COVID-19 infection, while blood group O might provide some protective effect. These results align with previous studies worldwide, suggesting that blood groups could influence the susceptibility to and severity of viral infections. The study emphasizes the need for further research with larger sample sizes and diverse populations to validate these findings and explore the underlying mechanisms.

Blood pressure pattern among blood donors exposed to SARS-CoV-2 in Luanda, Angola: A retrospective study

Background and Aims

SARS-CoV-2 infection is a public health concern. Several aspects related to the pattern of infection remain unclear. This study aimed to investigate the blood pressure pattern among blood donors exposed to SARS-CoV-2 in Luanda, Angola, a sub-Saharan African country.

Methods

We performed a retrospective analysis containing 343 blood donors from December 2019 to September 2020. Parametric tests compared means while χ 2 and logistic regression checked features associated with high blood pressure and were considered significant when p < 0.05.

Results

The mean age of blood donors was 32.2 ± 8.81 years (ranging from 18 to 61 years) and 93% of the men's gender. Overall, 4.7% of the studied population had been exposed to SARS-CoV-2. High blood pressure prevalence increased from unexposed to exposed SARS-CoV-2 (6.7%-18.8%, p = 0.071). SARS-CoV-2 exposure increase systole (131 ± 12.2 mmHg to 136 ± 14.2 mmHg, p = 0.098), diastole (79.9 ± 9.53 mmHg to 84.2 ± 12.7 mmHg, p = 0.086), pulse in beats per minute (72.0 ± 11.1 to 73.7 ± 8.50, p = 0.553), and decrease donating time (6.31 ± 3.72 min to 5.48 ± 1.61 min, p = 0.371). Chances of having high blood pressure were high [OR: 3.20 (95% confidence interval [CI]: 0.85-12.1), p = 0.086] in exposed SARS-CoV-2. Donors exposed to SARS-CoV-2 with abnormal donation time increased from the donor up to 40 years to over 40 years (from 35.7% to 50%, p = 0.696). The mean systolic, diastolic, and pulse pressure were higher for non-O donors (p > 0.05). A significant link was observed, between the Rhesus factor and blood pressure status (p = 0.032).

Conclusion

We showed important variations in blood pressure indices of the Angolan population exposed to SARS-CoV-2. Older age and non-O blood groups appear to be important biological factors for SARS-CoV-2 infection, as well as the risk of developing cardiovascular disease after or during SARS-CoV-2 exposure. Further studies assessing the impact on cardiovascular functions with ongoing or long-term SARS-CoV-2 exposure in individuals from resource-limited countries should be considered.

The Impact of Post-COVID-19 Syndrome in Adolescents: A Pilot Study

BACKGROUND

 Post-COVID-19 syndrome has emerged as a long-term complication in adults and children; its effect on adolescents' performance in school is not well studied.

OBJECTIVES

To study the physical/psychological impact of prolonged post-COVID-19 symptoms on school performance.

METHODS

 This is a cross-sectional study using Google Forms, a web-based fully anonymized survey of children in grades 10-12.

RESULTS

 The study included 54 students with a mean age of 16 years of whom 32 had COVID-19. Two were hospitalized and 10 had symptoms lasting more than four weeks. Commonly reported chronic symptoms were fatigue and cough. Seven students quit sports; eight had a decrease in their academic performance. Adolescents being infected more than once or not being fully vaccinated were more likely to develop prolonged symptoms and quit sports while academic performance in school was not affected. Three out of 10 (30%) students who had COVID-19 and responded to the questionnaire reported not seeking help.

CONCLUSION

Post-COVID-19 syndrome is associated with a decline in physical but not mental performance in school. Being infected more than once with SARS-CoV-2 seems to play an important role in the persistence of post-COVID-19 symptoms despite the fact that some adolescents are hesitant to seek medical or psychological care.

EVALUATION OF HUMAN ABO BLOOD GROUPS AND BLOOD COMPONENTS AMONG IRAQI PATIENTS INFECTED WITH CORONAVIRUS DISEASE 2019 (COVID-19)

OBJECTIVE

The aim: To evaluate the differences in blood groups, gender and type of Rh factor, as well as the levels of hemoglobin, white blood cells and platelets among patients infected with COVID-19.

PATIENTS AND METHODS

Materials and methods: A cross-sectional study was performed on 202 patients diagnosed with sever COVID-19 infection who were admitted to the Al-Shefaa center in Al- Hakeem hospital in Al-Najef city.Haematological investigations involved the types of blood groups, Rh factors, haemoglobin (Hb), white blood cells (WBCs), and platelets. In addition, the demographic features including age, gender and presence of any prescribed medications before or at the time of the study were also included.

RESULTS

Results: This study indicated that COVID-19 infected patients with type A blood group are at higher risk of hospitalization than other blood groups, and the majority of these patients were Rh positive. Additionally, WBCs counts indicated that the majority of patients had increased risk of getting infections which demonstrated lower WBC counts than normal. Platelet and Hb levels were normal for the majority of patients.

CONCLUSION

Conclusions: The findings of this study may help in the diagnosis of the pandemic infection with COVID-19, and prediction of the incidence of some complications caused by COVID-19. Further researches are warranted to confirm our findings.

Association of blood group with COVID-19 disease susceptibility and severity in Saudi Arabia

BACKGROUND

Novel SARS-CoV-2 (COVID-19) virus has rapidly spread worldwide and was declared a pandemic, making identifying and prioritizing individuals most at risk a critical challenge. The literature describes an association between blood groups and the susceptibility to various viral infections and their severity. Knowing if a specific blood group has more susceptibility to COVID-19 may help improve understanding the pathogenesis and severity of the disease. We aimed to assess the association between ABO/RhD and COVID-19 susceptibility and severity, and to compare results with similar studies in Saudi Arabia.

STUDY DESIGN AND METHODS

This study was conducted between March and October 2021 on 600 patients confirmed positive for COVID-19 infection. Patients' data were collected and analyzed. As a control, 8423 healthy blood donors were enrolled as a sample representative of the population for blood group distribution.

RESULTS

More individuals had blood group B in the COVID-19 group in comparison with the control group (24.2% vs. 18%), The opposite was observed among individuals of group O (39.5% vs. 47.3%). The B blood group was predictive of higher risk of mortality. No significant difference in the distribution of RhD was observed between the COVID-19 and the control groups. Neither ABO nor RhD was significantly associated with the severity of COVID-19.

DISCUSSION

Although there was no significant association with the disease severity, the B blood group may be associated with a higher risk for COVID-19 infection. Further studies with a larger sample size are necessary to evaluate this correlation.

Blood pH and COVID-19

The coronavirus disease 2019 (COVID-19) pandemic is a worldwide war. Raising the blood pH might be a crucial strategy to chase COVID-19. The human blood is slightly alkaline, which is essential for cell metabolism, normal physiology, and balanced immunity since all of these biological processes are pH-dependent. Varieties of physiologic derangements occur when the blood pH is disrupted. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) proliferates in acidic blood that magnifies the severity of COVID-19. On the other side, blood acidemia is linked to increased morbidity and mortality because of its complications on immunity, especially in the elderly and in critical diseases such as cancer, musculoskeletal degradation, renal, cardiac, and pulmonary disorders, which result in many pathological disorders such as osteomalacia, and disturbing the hematopoiesis. Additionally, acidemia of the blood facilitates viral infection and progression. Thus, correcting the acid-base balance might be a crucial strategy for the treatment of COVID-19, which might be attributed to the distraction of the viral spike protein to its cognate receptor angiotensin-converting enzyme 2 and supporting the over-taxed immunity.

ABO blood groups and the risk of SARS-CoV-2 infection

There is no doubt that genetic factors of the host play a role in susceptibility to infectious diseases. An association between ABO blood groups and SARS-CoV-2 infection as well as the severity of COVID-19 has been suggested relatively early during the pandemic and gained enormously high public interest. It was postulated that blood group A predisposes to a higher risk of infection as well as to a much higher risk of severe respiratory disease and that people with blood group O are less frequently and less severely affected by the disease. However, as to the severity of COVID-19, a thorough summary of the existing literature does not support these assumptions in general. Accordingly, at this time, there is no reason to suppose that knowledge of a patient's ABO phenotype should directly influence therapeutical decisions in any way. On the other hand, there are many data available supporting an association between the ABO blood groups and the risk of contracting SARS-CoV-2. To explain this association, several interactions between the virus and the host cell membrane have been proposed which will be discussed here.

Association of IgE elevation with blood group in COVID-19 patients

Aim : All parameters that are thought to be efficient in getting sick and follow-up of the disease should be investigated because of COVID-19 disease has serious consequences. The aim of this study was to investigate whether there is a relationship between the AB0 blood group with Rh factor systems and the frequency of catching COVID-19 infection and between IgE elevation according to blood groups and COVID-19 positivity. Material and Method: Blood groups and IgE levels of the control group (2690 patients) were compared retrospectively with 7300 patients who were admitted to our hospital between March 10, 2020, and March 31, 2021, and confirmed as COVID-19 positive with viral ribonucleic acid reverse transcriptase-polymerase chain reaction (RT-PCR). Results: It was found that among the blood groups, the highest COVID-19 positivity belonged to the A blood group (46.17%) and the lowest belonged to the AB blood group (9.04%). The increase in IgE elevation was found statistically significant in COVID-19 positive patients (P

The Clinical Utility of ABO and RHD Systems as Potential Indicators of Health Status, a Preliminary Study in Greek Population

Objective: The objective of this study is to further highlight the differences between different ABO blood groups and Rhesus types with health biomarkers. Methods: In total 150 active healthy blood donors participated in our study comprising of 80 males from 19–61 years and 70 females aged from 21 to 64. Participants carrying blood group A were 55 individuals, blood group B 32, blood group O 51, and blood group AB 12, RHD+ 132, and RHD- 18. All the volunteer regular blood donors were selected recognizing them as a healthy population excluding drug and supplements intake. Their blood samples were analyzed just before blood donation for biochemical, hematological, and antioxidant markers. Statistical computations were performed using the SPSS tool, specifically, the one-way ANOVA test, Chi-square statistics, and logistic regression were used as statistical models. Results: O blood donors presented better iron absorption and the worst lipid profile. Indeed, a significant trend of high atheromatic index values revealed an increased risk for hyperlipidemia, in contrast with blood group A presenting a better lipid profile with lower atheromatic index values. There was also a gender related association for blood group A compared with O that was further highlighted using binary logistic regression. Conclusion: In this study, a significant difference was observed among the ABO blood groups in several of the examined biochemical and hematological biomarkers. O blood group appeared different behavior in comparison to all the tested blood groups and furthermore the RHD-group presented a better lipid profile in comparison to the RHD+ group. In order to obtain a more comprehensive view of the correlation between the ABO blood group and biochemical markers, further studies are required.

Relationship between ABO Blood Group Distribution and COVID-19 Infection in Patients Admitted to the ICU: A Multicenter Observational Spanish Study

Since the beginning of the COVID-19 pandemic in December 2019, a relationship between the ABO blood group type and the novel coronavirus SARS-CoV-2, the etiological agent of COVID-19, has been reported, noting that individuals with the O blood group are the least likely to be infected. Spain is one of the most badly affected countries worldwide, with high rates of patients diagnosed, hospitalized, and deceased due to COVID-19 infection. The present study aimed to analyze the possible relationship of ABO in COVID-19 patients hospitalized in different Spanish centers during the first wave of the COVID-19 pandemic, for which the ABO group was available. Physicians from the transfusion services of different Spanish hospitals, who have developed a multicenter retrospective observational study, were invited to participate voluntarily in the research and 12,115 patients with COVID-19 infection were admitted to the nine participating hospitals. The blood group was known in 1399 cases (11.5%), of which 365 (26.1%) were admitted to the ICU. Regarding the distribution of ABO blood groups, a significant increase in the non-O blood groups and reduction for the O blood group was observed in patients hospitalized due to COVID-19, compared to the reference general population. Among the patients admitted to the ICU, after multivariate analysis, adjusted for the rest of the confounding variables, patients with the O blood group presented a significantly lower risk for admission to the ICU. We conclude that an association was observed between patients with the O blood group and their lower susceptibility to SARS-CoV-2 infection, both for those admitted to the hospitalization ward and for those who required admission to the ICU.

Does the Serum Concentration of Angiotensin II Type 1 Receptor Have an Effect on the Severity of COVID-19? A Prospective Preliminary Observational Study among Healthcare Professionals

SARS-CoV-2 is a virus that causes severe respiratory distress syndrome. The pathophysiology of COVID-19 is related to the renin-angiotensin system (RAS). SARS-CoV-2, a vector of COVID-19, uses angiotensin-converting enzyme 2 (ACE-2), which is highly expressed in human lung tissue, nasal cavity, and oral mucosa, to gain access into human cells. After entering the cell, SARS-CoV-2 inhibits ACE-2, thus favouring the ACE/Ang II/angiotensin II type 1 receptor (AT1R) axis, which plays a role in the development of acute lung injury (ALI). This study aimed to analyse the influence of angiotensin 1 receptor (AT1R) levels in the serum on the course of the severity of symptoms in healthcare professionals who had a SARS-CoV-2 infection. This prospective observational study was conducted on a group of 82 participants. The study group included physicians and nurses who had a COVID-19 infection confirmed by real-time reverse transcription-polymerase chain reaction (RT-PCR) test for SARS-CoV-2. The control group consisted of healthy medical professionals who had not had a SARS-CoV-2 infection or who had no symptoms of COVID-19 and who tested negative for SARS-CoV-2 on the day of examination. We analysed the correlation between AT1R concentration and the severity of COVID-19, as well as with sex, age, blood group, and comorbidities. There were no statistically significant differences in the mean values of AT1R concentration in the recovered individuals and the non-COVID-19 subjects (3.29 vs. 3.76 ng/mL; p = 0.32). The ROC curve for the AT1R assay showed an optimal cut-off point of 1.33 (AUC = 0.44; 95% CI = 0.32-0.57; p = 0.37). There was also no correlation between AT1R concentration and the severity of symptoms associated with COVID-19. Blood type analysis showed statistically significantly lower levels of AT1R in COVID-19-recovered participants with blood group A than in those with blood group O. In conclusion, AT1R concentration does not affect the severity of symptoms associated with COVID-19 among healthcare professionals.

Fallzahlen, Re-Identifikation und der technische Datenschutz

Die SARS-CoV-2-Pandemie hat viele sehr spezielle Fragen des Datenschutzes und der Datensicherheit aufgeworfen. Der vorliegende Beitrag widmet sich den mit der Veröffentlichung von Infiziertenzahlen verbundenen Re-Identifikationsrisiken. Er zeigt einen Weg auf, diese Risiken mit Mitteln des technischen Datenschutzes zu reduzieren, um sowohl das öffentliche Informationsbedürfnis zu befriedigen als auch das informelle Selbstbestimmungsrecht der Betroffenen zu wahren.

COVID-19 in Patients with Transfusion Dependent Thalassemia (TDT) in Indonesia: Characteristics of the Disease and Patients, and Comparison between Epidemiological Data for COVID-19 and Thalassemia in Indonesia and Southeast Asia

Background: People living with transfusion dependent thalassemia have a high risk of becoming infected with COVID-19. This can be caused by both internal factors, namely the formation of alloantibodies and autoimmune disorder, and external factors such as routine visits for blood transfusions. Chronic complications of thalassemia also render them more vulnerable to infectious diseases, including COVID-19. However, anecdotal data shows that thalassemia patients experience less incidence of COVID-19 compared to the general population. Purpose: This study aims to find the correlation between COVID-19 in thalassemia-dependent transfusion patients in Indonesia and Southeast Asia. Patients and Methods: This study used a cross-sectional design. The study was conducted at the Division of Hematology and Medical Oncology of the Cipto Mangunkusumo Hospital in Jakarta from May 2020–August 2021. The total sampling method was used involving all thalassemia major patients who had been infected with COVID-19 (obtained directly from medical record and through the thalassemia patients-parents foundation). Results: From 10,397 patients with thalassemia, 67 (0.64%) people were infected by COVID-19 and 2 (2.9%) were deceased. Meanwhile, the incidence of COVID-19 in the general population of Indonesia was 0.87% (more than in the thalassemia population). This means that thalassemia might provide additional protection against COVID-19 due to several mechanisms. This phenomenon has also been seen in other countries with a high prevalence of thalassemia, wherein there are less COVID-19 cases despite the pandemic. On the contrary, countries with low rates of thalassemia had experienced deadly surges of the pandemic. Conclusion: Indonesia and other countries with a high prevalence of thalassemia have lower COVID-19 incidence than countries with low prevalence of thalassemia. Thalassemia might provide additional protection against COVID-19. Well-designed studies are needed to provide better evidence on the protective effect of thalassemia on COVID-19.

Association of Covid-19 with blood type A in relation to blood sugar, urea, and blood test (D-dimer and ferritin) in patients from Al-Najaf

COVID-19 is an emerging infectious disease caused by the novel enveloped single-stranded RNA virus quickly declared a pandemic. This study aimed to investigate the severity of COVID-19 infection in patients with blood group type A. A cross-sectional study was conducted at Al-Amal specialized hospital, Al-Najaf (March 8 to March 20/2021). The study included 123 hospitalized patients (63 females and 60 males), aged between 15-95 years, diagnosed with COVID-19, tested for blood group, blood sugar, blood urea, D-dimer, and serum ferritin. Results indicated significant differences in blood sugar and D-dimer in patients with type A blood group at P>0.05. At the same time, no significant difference was found in blood urea and ferritin at P>0.05. The majority of patients showed elevated levels of blood sugar, blood urea, serum D-dimer and ferritin. COVID-19 can infect people of all ages and causes severe infection in all blood groups.

The Potential Impact of Blood System on Dietary Habits and Smoking

The 'Blood-Type' diet advises individuals to eat according to their ABO blood group to improve their health and decrease the risk of chronic diseases. However, the food preferences of individuals with different blood groups have not been examined. The aim of our study was to investigate, in healthy regular blood donors (rBDs), the associations of smoke, alcohol, caffeine, vitamin and fat intake with their different blood groups and if ABO groups could be a potential predictor tool for disease prevention. A total of 329 volunteers were divided into four groups according to their ABO types: Group 1 (A) comprised 141 rBDs; Group 2 (B), 65 rBDs; Group 3 (O), 96 rBDs; and Group 4, 27 rBDs. Additionally, they were divided into two groups according to their rhesus types and their preferences for smoke, too. Dietary intake was assessed using 3-day food recall and the Food Processor computer program for nutrient analysis. Alcohol, caffeine, sugar and Vitamin D consumption were significantly (p < 0.05) higher in the O group. The A group presented statistically significantly (p < 0.05) greater preferences for cholesterol intake and a higher trend for smoking (25%) habits compared with all the other groups, whereas Group B preferred more fatty foods. The blood group AB appeared to be the most controlled food intake group. Regarding the rhesus comparisons, alcohol; caffeine; and Vitamin C, D, E and K consumptions were significantly (p < 0.05) higher in rhesus-positive individuals than their rhesus-negative counterparts. For the non-smoker group, compared with the smokers, a higher consumption of Vitamin D and fibers was found. In conclusion, in the present study, statistically significant correlations of the ABO and rhesus system with some dietary parameters were found, indicating a consequent influence of these preferences on the progression of different diseases.

Evaluation of the Bactericidal Activity of Galectins

Over a century ago, Karl Landsteiner discovered that blood group antigens could predict the immunological outcome of red blood cell transfusion. While the discovery of ABO(H) blood group antigens revolutionized transfusion medicine, many questions remain regarding the development and regulation of naturally occurring anti-blood group antibody formation. Early studies suggested that blood group antibodies develop following stimulation by bacteria that express blood group antigens. While this may explain the development of anti-blood group antibodies in blood group-negative individuals, how blood group-positive individuals protect themselves against blood group-positive microbes remained unknown. Recent studies suggest that several members of the galectin family specifically target blood group-positive microbes, thereby providing innate immune protection against blood group antigen-positive microbes regardless of the blood group status of an individual. Importantly, subsequent studies suggest that this unique form of immunity may not be limited to blood group expressing microbes, but may reflect a more generalized form of innate immunity against molecular mimicry. As this form of antimicrobial activity represents a unique and unprecedented form of immunity, we will examine important considerations and methodological approaches that can be used when seeking to ascertain the potential antimicrobial activity of various members of the galectin family.

Effect of ABO blood groups on length of hospital stay according to age in Covid-19 patients

INTRODUCTION

Coronavirus Disease 2019 (COVID-19) is a novel viral disease with person-to-person transmission that has spread to many countries since the end of 2019. Although many unknowns were resolved within a year and the vaccine is available, it is still a major global health problem.

OBJECTIVE

COVID-19 infection may present with a considerably wide spectrum of severity and host factors play a significant role in determining the course of the disease. One of these factors is blood groups. Based on previous experience, it is believed that the ABO blood group type affects prognosis, treatment response and length of stay in the hospital. In this study, our aim was to evaluate whether the blood group had an effect on the length of the hospital stay. To the best of our knowledge, no previous studies have assessed the effect of ABO blood groups, as well as age, on the length of the hospital stay in these settings.

METHODS

In this retrospective cohort study, 969 patients admitted to our hospital between March 15, 2020 and May 15, 2020 were evaluated. The patients were divided into 4 groups according to ABO blood groups. The effect of the ABO blood group by age on the course of the disease, need for intensive care, duration of hospitalization and mortality in patients with COVID-19 infection, especially in geriatric patients, was evaluated.

RESULTS

Of all the patients, 9.1% required admission to the intensive care unit (ICU), of whom 83% died. The average length of ICU stay was 11 days (0 - 59). The observed mortality rates in blood groups A, B, AB and 0 were 86.4%, 93.3%, 80.0% and 70.8%, respectively, indicating similar death rates in all ABO blood types. When the Rh phenotype was taken into consideration, no significant changes in results were seen.

CONCLUSION

As a result, we could not observe a significant relationship between blood groups and clinical outcomes in this study, which included a sample of Turkish patients with COVID-19.

Blood Types and Severity of COVID-19

Aim: Since blood types first appeared, their association with diseases caused by microorganisms has been further investigated with several studies for many years. The bond of blood groups described as A, B, AB, and O with coronavirus has been the research subject in many countries.We aimed to elucidate whether there was a relationship between blood types and Rh factor and contracting COVID-19 disease and disease severity. Methods: The study was designed as a retrospective case-control study. Between March 2020 - February 2021, 1110 patients were included (538 cases, 572 controls). Disease severity was classified according to where patients were treated: those who were outpatients considered as “mild disease”, hospitalized in a hospital ward considered as “moderate disease”, and treated in the intensive care unit were considered as “severe disease”. Results: The number of people with blood type A was 447 (40.3%), blood type B was 197 (17.7%), blood type AB was 90 (%8), and blood type O was 376 (33.9%). There was no significant difference between the case and control groups according to the blood types. A 3.93 times increase of developing mild illness was detected compared to the control group in Rh-positive individuals. The rate of developing a severe disease was higher in females with blood type A than a mild disease, and A blood type caused the disease to be severe compared to other blood groups in females. Conclusion: We concluded that blood type A caused more severe disease than other blood types in females, and females with B blood type survived the disease as outpatients. Our study can shed light on pathophysiological investigation of the relationship between COVID-19 disease causing a pandemic with high mortality and virulence and blood types. Keywords: COVID-19 virus, blood group, disease

Generation and Export of Red Blood Cell ATP in Health and Disease

Metabolic homeostasis in animals depends critically on evolved mechanisms by which red blood cell (RBC) hemoglobin (Hb) senses oxygen (O₂) need and responds accordingly. The entwined regulation of ATP production and antioxidant systems within the RBC also exploits Hb-based O₂-sensitivity to respond to various physiologic and pathophysiologic stresses. O₂ offloading, for example, promotes glycolysis in order to generate both 2,3-DPG (a negative allosteric effector of Hb O₂ binding) and ATP. Alternatively, generation of the nicotinamide adenine dinucleotide phosphate (NADPH) critical for reducing systems is favored under the oxidizing conditions of O₂ abundance. Dynamic control of ATP not only ensures the functional activity of ion pumps and cellular flexibility, but also contributes to the availability of vasoregulatory ATP that can be exported when necessary, for example in hypoxia or upon RBC deformation in microvessels. RBC ATP export in response to hypoxia or deformation dilates blood vessels in order to promote efficient O₂ delivery. The ability of RBCs to adapt to the metabolic environment via differential control of these metabolites is impaired in the face of enzymopathies [pyruvate kinase deficiency; glucose-6-phosphate dehydrogenase (G6PD) deficiency], blood banking, diabetes mellitus, COVID-19 or sepsis, and sickle cell disease. The emerging availability of therapies capable of augmenting RBC ATP, including newly established uses of allosteric effectors and metabolite-specific additive solutions for RBC transfusates, raises the prospect of clinical interventions to optimize or correct RBC function via these metabolite delivery mechanisms.

Profiling serum levels of glutathione reductase and interleukin-10 in positive and negative-PCR COVID-19 outpatients: A comparative study from southwestern Iran

Since the outbreak of COVID-19 in China, it has rapidly spread across many other countries. We evaluated antioxidant defense systems and inflammatory status related to the SARS-CoV2 infection in a population from southwestern Iran. Comorbidities and clinical symptoms of 104 subjects (comprising negative and positive-PCR COVID-19 outpatients) were assessed. Serum concentrations of glutathione reductase (GR) and interleukin-10 (IL-10) were measured using ELISA. In the positive-PCR group, follow-ups on clinical symptoms were carried out for 28 days at 7-day intervals. In the positive-PCR group, hypertension, diabetes, liver disease, chronic heart disease, and chronic kidney disease were the most common comorbidities. In the general category of symptoms, we found a significant difference between negative and positive-PCR groups, except regarding runny noses. In the pulmonary category, there was a significant difference between the two groups except in terms of chest pain. We also determined a significant difference in neurologic symptoms, except for ear pain, between negative and positive-PCR groups. We also found significantly lower levels of GR but higher levels of IL-10 in the positive-PCR group (p = 0.000 for both). In the positive-PCR group, serum levels of IL-10 (odds ratio = 0.914, p = 0.012) decreased the chances of neurological symptoms occurring over time. The antioxidant defense systems of positive-PCR outpatients failed as demonstrated by a reduction in the serum levels of GR. We also indicated a dysregulation in the immune response against COVID-19, characterized by changes in serum IL-10 levels.

Association of ABO and Rh Blood Group in Susceptibility, Severity, and Mortality of Coronavirus Disease 2019: A Hospital-Based Study From Delhi, India

Background

ABO and Rh blood group systems are associated with many diseases including cancerous, infectious, non-infectious, bacterial and viral diseases. Studies have shown association of blood groups A and O with higher and lower odds for coronavirus disease 2019 positivity, respectively.

Methods

This is a single-center, retrospective study conducted at Sir Ganga Ram Hospital, Delhi. We investigated the association of ABO and Rh blood groups with susceptibility to coronavirus disease 2019 infection, severity of disease, recovery period, and mortality of patients. Patients were enrolled from April 8, 2020 to October 4, 2020. A total of 2,586 real-time PCR (RT-PCR)-confirmed coronavirus disease 2019 (COVID-19) patients were recruited. Data was analyzed using chi-square test, odds ratio, and Mann–Whitney test to determine the association of blood groups.

Results

In the 2,586 COVID-19-infected patients, the frequencies of A, B, O, and AB were 29.93%, 41.80%, 21.19%, and 7.98%, respectively. Of the patients, 98.07% were Rh positive. Blood group A (odds ratio, 1.53; CI, 1.40–1.66; p < 0.001) and B (odds ratio, 1.15; CI, 1.06–1.24; p < 0.001) is observed to be significantly associated with COVID-19 susceptibility, whereas blood group O (odds ratio, 0.65; CI, 0.59–0.71; p < 0.001) and AB (odds ratio, 0.66; CI, 0.59–0.71; p < 0.001) have low risk of COVID-19 infection.

Conclusion

A, B, and Rh+ are found to be more susceptible to COVID-19 infection, whereas blood groups O, AB, and Rh− are at a lower risk of COVID-19 infection. No association was found between blood groups and susceptibility to severity of disease and mortality.

Variation of Genomic Sites Associated with Severe Covid-19 Across Populations: Global and National Patterns

Background

Information about the distribution of clinically significant genetic markers in different populations may be helpful in elaborating personalized approaches to the clinical management of COVID-19 in the absence of consensus guidelines.

Aim

Analyze frequencies and distribution patterns of two markers associated with severe COVID-19 (rs11385942 and rs657152) and look for potential correlations between these markers and deaths from COVID-19 among populations in Russia and across the world.

Methods

We genotyped 1883 samples from 91 ethnic groups pooled into 28 populations representing Russia and its neighbor states. We also compiled a dataset on 32 populations from other regions using genotypes extracted or imputed from the available databases. Geographic maps showing the frequency distribution of the analyzed markers were constructed using the obtained data.

Results

The cartographic analysis revealed that rs11385942 distribution follows the West Eurasian pattern: the marker is frequent among the populations of Europe, West Asia and South Asia but rare or absent in all other parts of the globe. Notably, the transition from high to low rs11385942 frequencies across Eurasia is not abrupt but follows the clinal variation pattern instead. The distribution of rs657152 is more homogeneous. The analysis of correlations between the frequencies of the studied markers and the epidemiological characteristics of COVID-19 in a population revealed that higher frequencies of both risk alleles correlated positively with mortality from this disease. For rs657152, the correlation was especially strong (r = 0.59, p = 0.02). These reasonable correlations were observed for the "Russian" dataset only: no such correlations were established for the "world" dataset. This could be attributed to the differences in methodology used to collect COVID-19 statistics in different countries.

Conclusion

Our findings suggest that genetic differences between populations make a small yet tangible contribution to the heterogeneity of the pandemic worldwide.

Aging whole blood transcriptome reveals candidate genes for SARS-CoV-2-related vascular and immune alterations

Abstract

The risk of severe COVID-19 increases with age as older patients are at highest risk. Thus, there is an urgent need to identify how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) interacts with blood components during aging. We investigated the whole blood transcriptome from the Genotype-Tissue Expression (GTEx) database to explore differentially expressed genes (DEGs) translated into proteins interacting with viral proteins during aging. From 22 DEGs in aged blood, FASLG, CTSW, CTSE, VCAM1, and BAG3 were associated with immune response, inflammation, cell component and adhesion, and platelet activation/aggregation. Males and females older than 50 years old overexpress FASLG, possibly inducing a hyperinflammatory cascade. The expression of cathepsins (CTSW and CTSE) and the anti-apoptotic co-chaperone molecule BAG3 also increased throughout aging in both genders. By exploring single-cell RNA-sequencing data from peripheral blood of SARS-CoV-2-infected patients, we found FASLG and CTSW expressed in natural killer cells and CD8 + T lymphocytes, whereas BAG3 was expressed mainly in CD4 + T cells, naive T cells, and CD14 + monocytes. In addition, T cell exhaustion was associated with increased expression of CCL4L2 and DUSP4 over blood aging. LAG3, PDCD1, TIGIT, VCAM1, HLA-DRA, and TOX also increased in individuals aged 60–69 years old; conversely, the RGS2 gene decreased with aging. We further identified a distinct gene expression profile associated with type I interferon signaling following blood aging. These results revealed changes in blood molecules potentially related to SARS-CoV-2 infection throughout aging, emphasizing them as therapeutic candidates for aggressive clinical manifestation of COVID-19.

Key messages

• Prediction of host-viral interactions in the whole blood transcriptome during aging.

• Expression levels of FASLG, CTSW, CTSE, VCAM1, and BAG3 increase in aged blood.

• Blood interactome reveals targets involved with immune response, inflammation, and blood clots.

• SARS-CoV-2-infected patients with high viral load showed FASLG overexpression.

• Gene expression profile associated with T cell exhaustion and type I interferon signaling were affected with blood aging.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00109-021-02161-4.

A Comprehensive Overview of the Newly Emerged COVID-19 Pandemic: Features, Origin, Genomics, Epidemiology, Treatment, and Prevention

The coronavirus disease 2019 (COVID-19), a life-threatening pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has resulted in massive destruction and is still continuously adding to its death toll. The advent of this global outbreak has not yet been confirmed; however, investigation for suitable prophylaxis against this lethal virus is being carried out by experts all around the globe. The SARS-CoV-2 belongs to the Coronaviridae superfamily, like the other previously occurring human coronavirus variants. To better understand a new virus variant, such as the SARS-CoV-2 delta variant, it is vital to investigate previous virus strains, including their genomic composition and functionality. Our study aimed at addressing the basic overview of the virus’ profile that may provide the scientific community with evidence-based insights into COVID-19. Therefore, this study accomplished a comprehensive literature review that includes the virus’ origin, classification, structure, life cycle, genome, mutation, epidemiology, and subsequent essential factors associated with host–virus interaction. Moreover, we summarized the considerable diagnostic measures, treatment options, including multiple therapeutic approaches, and prevention, as well as future directions that may reduce the impact and misery caused by this devastating pandemic. The observations and data provided here have been screened and accumulated through extensive literature study, hence this study will help the scientific community properly understand this new virus and provide further leads for therapeutic interventions.

Can the Cytokine Profile According to ABO Blood Groups Be Related to Worse Outcome in COVID-19 Patients? Yes, They Can

Severe status of coronavirus disease 2019 (COVID-19) is extremely associated to cytokine release. Moreover, it has been suggested that blood group is also associated with the prevalence and severity of this disease. However, the relationship between the cytokine profile and blood group remains unclear in COVID-19 patients. In this sense, we prospectively recruited 108 COVID-19 patients between March and April 2020 and divided according to ABO blood group. For the analysis of 45 cytokines, plasma samples were collected in the time of admission to hospital ward or intensive care unit and at the sixth day after hospital admission. The results show that there was a risk of more than two times lower of mechanical ventilation or death in patients with blood group O (log rank: p = 0.042). At first time, all statistically significant cytokine levels, except from hepatocyte growth factor, were higher in O blood group patients meanwhile the second time showed a significant drop, between 20% and 40%. In contrast, A/B/AB group presented a maintenance of cytokine levels during time. Hepatocyte growth factor showed a significant association with intubation or mortality risk in non-O blood group patients (OR: 4.229, 95% CI (2.064-8.665), p < 0.001) and also was the only one bad prognosis biomarker in O blood group patients (OR: 8.852, 95% CI (1.540-50.878), p = 0.015). Therefore, higher cytokine levels in O blood group are associated with a better outcome than A/B/AB group in COVID-19 patients.

ABO Blood Group and Outcomes in Patients with COVID-19 Admitted in the Intensive Care Unit (ICU): A Retrospective Study in a Tertiary-Level Hospital in Bangladesh

PURPOSE

The world is heavily suffering from the COVID-19 pandemic for more than a year, with over 191 million confirmed cases and more than 4.1 million deaths to date. Previous studies have explored several risk factors for coronavirus disease 2019 (COVID-19), but there is still a lack of association with ABO blood type. This study aimed to find out the relationship between the ABO blood group and COVID-19 outcomes in Bangladesh.

SUBJECTS AND METHODS

This retrospective cross-sectional study was conducted in the intensive care unit (ICU) of a tertiary-level COVID-dedicated hospital in Dhaka city, Bangladesh, between April 2020 and November 2020. Records from 771 critically ill patients were extracted who were confirmed for COVID-19 by reverse transcriptase-polymerase chain reaction (RT-PCR) assay, and blood grouping records were available in the health records.

RESULTS

The blood groups were 37.35%, 17.38%, 26.46%, and 18.81% for A, B, AB, and O type, respectively. Clinical symptoms were significantly more common in patients with blood type A (p < 0.05). Patients with blood type A had higher WBC counts and peak serum ferritin levels and both were statistically significant (p < 0.001). Patients with blood type A had a greater need for supplemental oxygen, and they were more likely to die in comparison to the patients with other blood types (p < 0.05). In multivariable analysis, our primary outcome death was significantly associated with blood type A (AOR: 3.49, 95% CI: 1.57-7.73) while adjusting for age, male gender, and non-communicable diseases.

CONCLUSION

Based on this study results, it can be concluded that the COVID-19 patients with blood type A have a higher chance of death and other complications. The authors recommend blood grouping before treating the COVID-19 patients, and healthcare workers should prioritize treating the patients based on that result.

Major Insights in Dynamics of Host Response to SARS-CoV-2: Impacts and Challenges

The coronavirus disease 2019 (COVID-19), a pandemic declared by the World Health Organization on March 11, 2020, is caused by the infection of highly transmissible species of a novel coronavirus called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). As of July 25, 2021, there are 194,372,584 cases and 4,167,937 deaths with high variability in clinical manifestations, disease burden, and post-disease complications among different people around the globe. Overall, COVID-19 is manifested as mild to moderate in almost 90% of the cases and only the rest 10% of the cases need hospitalization. However, patients with older age and those having different comorbidities have made worst the pandemic scenario. The variability of pathological consequences and clinical manifestations of COVID-19 is associated with differential host-SARS-CoV-2 interactions, which are influenced by the factors that originated from the SARS-CoV-2 and the host. These factors usually include the genomic attributes and virulent factors of the SARS-CoV-2, the burden of coinfection with other viruses and bacteria, age and gender of the individuals, different comorbidities, immune suppressions/deficiency, genotypes of major histocompatibility complex, and blood group antigens and antibodies. We herein retrieved and reviewed literatures from PubMed, Scopus, and Google relevant to clinical complications and pathogenesis of COVID-19 among people of different age, sex, and geographical locations; genomic characteristics of SARS-CoV-2 including its variants, host response under different variables, and comorbidities to summarize the dynamics of the host response to SARS-CoV-2 infection; and host response toward approved vaccines and treatment strategies against COVID-19. After reviewing a large number of published articles covering different aspects of host response to SARS-CoV-2, it is clear that one aspect from one region is not working with the scenario same to others, as studies have been done separately with a very small number of cases from a particular area/region of a country. Importantly, to combat such a pandemic as COVID-19, a conclusive understanding of the disease dynamics is required. This review emphasizes on the identification of the factors influencing the dynamics of host responses to SARS-CoV-2 and offers a future perspective to explore the molecular insights of COVID-19.

Risk Factors Associated with the Clinical Outcomes of COVID-19 and Its Variants in the Context of Cytokine Storm and Therapeutics/Vaccine Development Challenges

The recent appearance of SARS-CoV-2 is responsible for the ongoing coronavirus disease 2019 (COVID-19) pandemic and has brought to light the importance of understanding this highly pathogenic agent to prevent future pandemics. This virus is from the same single-stranded positive-sense RNA family, Coronaviridae, as two other epidemic-causing viruses, SARS-CoV-1 and MERS-CoV. During this pandemic, one crucial focus highlighted by WHO has been to understand the risk factors that may contribute to disease severity and predict COVID-19 outcomes. In doing so, it is imperative to understand the virology of SARS-CoV-2 and the immunological response eliciting the clinical manifestation and progression of COVID-19. In this review, we provide clinical data-based analyses of how multiple risk factors (such as sex, race, HLA genotypes, blood groups, vitamin D deficiency, obesity, smoking, and asthma) contribute to the inflammatory overactivation and cytokine storm (frequently seen in COVID-19 patients) with a focus on the IL-6 pathway. We also draw comparisons to the virulence and pathophysiology of SARS and MERS to establish parallels in immune response and discuss the potential for therapeutic approaches that may limit disease progression in patients with higher risk profiles than others. Moreover, we cover the latest information on approved or upcoming COVID-19 vaccines. This paper also provides perspective on emerging variants and associated opportunistic infections such as black molds and fungus that have added to mortality in some parts of the world, such as India. This compilation of existing COVID-19 studies and data will provide an excellent referencing tool for the research, clinical, and public health communities.

Association of ABO and Rh blood groups with obstetric outcomes in SARS-CoV-2 infected pregnancies: A prospective study with a multivariate analysis

Objective

To evaluate the influence of ABO and Rh blood groups on morbidity among SARS-CoV-2 infected pregnancies.

Design

Prospective observational study.

Setting

78 centers of the Spanish Obstetric Emergency Group.

Population

Pregnant women with SARS-CoV-2 tested with polymerase-chain-reaction between 26-February and 5-November 2020. A cohort of 1278 SARS-CoV-2(+) pregnant women was analyzed and a concurrent comparison group of 1453 SARS-COV-2(−) patients was established.

Methods

Data were collected from medical charts. SARS-COV-2(+) was compared with SARS-COV-2(−) for differences in distribution of blood groups. We performed multivariate analysis, controlling for maternal age and ethnicity, to evaluate association of ABO and Rh blood groups with maternal and perinatal outcomes in SARS-CoV-2(+) patients with adjusted odds ratios (aOR) and 95% confidence intervals (CI).

Main outcomes measures

Medical morbidity: Symptomatic COVID-19 and medical complications. Obstetric outcomes: caesarean delivery, preterm deliveries, preterm premature rupture of membranes (PPROM), hemorrhagic events, pre-eclampsia, maternal and neonatal mortality, stillbirth.

Results

Differences were noted between blood types and Rh for age and ethnicity comparing SARS-CoV-2(+) and SARS-CoV-2(−) groups (p < 0.05). Among the SARS-CoV-2(+) cohort, the odds of symptomatic COVID-19 and obstetric hemorrhagic event were higher in Rh+ vs Rh− mothers (aOR 1.48, 95% CI 1.02–2.14, p = 0.037, and aOR 8.72, 95% CI 1.20–63.57, p = 0.033, respectively), and PPROM were higher among blood type A vs non-A mothers (aOR 2.06, 95% CI 1.01–4.18, p = 0.046).

Conclusions

In SARS-CoV-2(+) pregnant women, Rh− status was associated with a lower risk of symptomatic COVID-19, while Rh+ and blood group A were associated with obstetric hemorrhage and PPROM, respectively.

Genetic Control of Human Infection with SARS-CoV-2

In 2019, the SARS-CoV-2 beta-coronavirus, which caused a pandemic of severe acute respiratory viral infection COVID-19 (from COronaVIrus Disease 2019), was first detected. The susceptibility to SARS-CoV-2 and the nature of the course of the COVID-19 clinical picture are determined by many factors, including genetic characteristics of both the pathogen and the human. The SARS-CoV-2 genome has a similarity to the genomes of other coronaviruses, which are pathogenic for humans and cause a severe course of infection: 79% to the SARS-CoV genome and 50% to the MERS-CoV genome. The most significant differences between SARS-CoV-2 and other coronaviruses are recorded in the structure of the gene of the S protein, a key protein responsible for the virus binding to the receptor of the host organism cells. In particular, substitutions in the S protein of SARS-CoV-2, leading to the formation of the furin cleavage site that is absent in other SARS-like coronaviruses, were identified, which may explain the high pathogenicity of SARS-CoV-2. In humans, the genes that are significant for the initial stages of infection include ACE2, ANPEP, DPP4 (encode receptors for coronavirus binding); TMPRSS2, FURIN, TMPRSS11D, CTSL, CTSB (encode proteases involved in the entry of the coronavirus into the cell); DDX1 (the gene of ATP-dependent RNA helicase DDX1, which promotes replication of coronaviruses); and IFITM1, IFITM2, and IFITM3 (encode interferon-induced transmembrane proteins with an antiviral effect). These genes are expressed in many tissues (including those susceptible to the effects of SARS-CoV-2); rare and frequent variants that affect the structure of the encoded protein and its properties and expression level are described in them. A number of common genetic variants with proven functional significance are characterized by the variability in the allele frequency in the world's populations, which can determine interpopulation differences in the prevalence of COVID-19 and in the clinical features of the course of this pathology. The expression level of genes that are important for the formation of the susceptibility to SARS-CoV-2 is affected by epigenetic modifications, comorbidities at the time of infection, taking medications, and bad habits.

Uncurtaining the effect of COVID-19 in diabetes mellitus: a complex clinical management approach

The aim of the present review is to overview the common properties of corona virus and hence proofs well beginning of corona virus in persons with diabetes, and its treatment. Globally, it has been observed that according to the statistics, India has the second largest number of people with diabetes. Literature review has been implemented within the databases using suitable keywords. For persons suffering from diabetic disorder, the COVID-19 infection becomes a dual challenge. Diabetes is a severe metabolic situation which causes the sugar levels in the blood to increase than the normal level. Normally, communicable disease like COVID-19 is more prevailing in patients with diabetes. Diabetic patient has poor immune response to infections. The different bacterial, viral, parasitic, and mycotic infections showed increased probability in diabetic patients as compared to non-diabetic patient. All these conclusions clear out the intention that the diabetic patients are more susceptible to enhanced inflammatory response that may lead to rapid spreading of COVID-19 infection with high rate of mortality. In the present situation of pandemic, managing diabetes seems to be quite challenging and diabetic patient having COVID-19 infection should follow normal course of antihypertensive and antidiabetic drugs prescribed with the exception of sodium glucose co-transpoters-2 inhibitors which would increase the risk of dehydration and ketoacidosis. In view of above discussion, this article highlights the proposed mechanism of COVID-19 infection linking it with diabetes, antidiabetic drugs to be used in COVID-19 infection along with their advantages, and disadvantages and management of COVID-19 infection diabetic patient.

Machine Learning for Analyzing Non-Countermeasure Factors Affecting Early Spread of COVID-19

The COVID-19 pandemic affected the whole world, but not all countries were impacted equally. This opens the question of what factors can explain the initial faster spread in some countries compared to others. Many such factors are overshadowed by the effect of the countermeasures, so we studied the early phases of the infection when countermeasures had not yet taken place. We collected the most diverse dataset of potentially relevant factors and infection metrics to date for this task. Using it, we show the importance of different factors and factor categories as determined by both statistical methods and machine learning (ML) feature selection (FS) approaches. Factors related to culture (e.g., individualism, openness), development, and travel proved the most important. A more thorough factor analysis was then made using a novel rule discovery algorithm. We also show how interconnected these factors are and caution against relying on ML analysis in isolation. Importantly, we explore potential pitfalls found in the methodology of similar work and demonstrate their impact on COVID-19 data analysis. Our best models using the decision tree classifier can predict the infection class with roughly 80% accuracy.

Role of ABO blood system in COVID-19: Findings from a southern Italian study

BACKGROUND

COVID-19 is a worldwide infection caused by SARS-CoV-2 and infects humans by binding to the ACE2 receptor. Blood group ABO glycoproteins can influence the binding of the virus to ACE2. The role of ABO blood system in the susceptibility to infection as well as in the clinical outcome of infected patients is still controversial and needs to be clarified.

METHODS

We conducted a retrospective study of 167 patients positive for SARS-CoV-2 who underwent nasopharyngeal swab, and of a control group represented by 891 subjects negative for SARS-CoV-2, to assess the association between ABO and Rh blood system and occurrence of SARS-CoV-2 infection, clinical presentation, and outcome of disease.

RESULTS

In the cohort of patients positive for SARS-CoV-2, no statistically significant difference in the distribution of ABO blood types compared with controls was observed. Patients with blood type A had a higher risk of developing symptomatic disease (p = 0.002; odds ratio [OR = 3.592]; 95% confidence interval [CI] = 1.576-8.187) compared to patients with blood types B, AB, and O. Patients with blood types B (p = 0.021; OR = 0.293; 95%CI = 0.099-0.869) and O (p = 0.018; OR = 0.417; 95%CI = 0.199-0.871) showed a lower risk in comparison to the other groups. The clinical progression to mild/moderate and severe/critical disease and the mortality showed no association. Moreover, no relationship with Rh blood type was found.

CONCLUSIONS

Our findings support a role of ABO blood type in the development of symptomatic disease with a higher risk in subjects with blood type A and a protective effect of blood types B and O. Blood types do not seem, however, to play a role in susceptibility, progression to severe disease, and death.

Multi-omics highlights ABO plasma protein as a causal risk factor for COVID-19

SARS-CoV-2 is responsible for the coronavirus disease 2019 (COVID-19) and the current health crisis. Despite intensive research efforts, the genes and pathways that contribute to COVID-19 remain poorly understood. We, therefore, used an integrative genomics (IG) approach to identify candidate genes responsible for COVID-19 and its severity. We used Bayesian colocalization (COLOC) and summary-based Mendelian randomization to combine gene expression quantitative trait loci (eQTLs) from the Lung eQTL (n = 1,038) and eQTLGen (n = 31,784) studies with published COVID-19 genome-wide association study (GWAS) data from the COVID-19 Host Genetics Initiative. Additionally, we used COLOC to integrate plasma protein quantitative trait loci (pQTL) from the INTERVAL study (n = 3,301) with COVID-19 loci. Finally, we determined any causal associations between plasma proteins and COVID-19 using multi-variable two-sample Mendelian randomization (MR). The expression of 18 genes in lung and/or blood co-localized with COVID-19 loci. Of these, 12 genes were in suggestive loci (PGWAS < 5 × 10-05). LZTFL1, SLC6A20, ABO, IL10RB and IFNAR2 and OAS1 had been previously associated with a heightened risk of COVID-19 (PGWAS < 5 × 10-08). We identified a causal association between OAS1 and COVID-19 GWAS. Plasma ABO protein, which is associated with blood type in humans, demonstrated a significant causal relationship with COVID-19 in the MR analysis; increased plasma levels were associated with an increased risk of COVID-19 and, in particular, severe COVID-19. In summary, our study identified genes associated with COVID-19 that may be prioritized for future investigations. Importantly, this is the first study to demonstrate a causal association between plasma ABO protein and COVID-19.

Prediction of COVID-19 Hospital Length of Stay and Risk of Death Using Artificial Intelligence-Based Modeling

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious virus with overwhelming demand on healthcare systems, which require advanced predictive analytics to strategize COVID-19 management in a more effective and efficient manner. We analyzed clinical data of 2017 COVID-19 cases reported in the Dubai health authority and developed predictive models to predict the patient's length of hospital stay and risk of death. A decision tree (DT) model to predict COVID-19 length of stay was developed based on patient clinical information. The model showed very good performance with a coefficient of determination R² of 49.8% and a median absolute deviation of 2.85 days. Furthermore, another DT-based model was constructed to predict COVID-19 risk of death. The model showed excellent performance with sensitivity and specificity of 96.5 and 87.8%, respectively, and overall prediction accuracy of 96%. Further validation using unsupervised learning methods showed similar separation patterns, and a receiver operator characteristic approach suggested stable and robust DT model performance. The results show that a high risk of death of 78.2% is indicated for intubated COVID-19 patients who have not used anticoagulant medications. Fortunately, intubated patients who are using anticoagulant and dexamethasone medications with an international normalized ratio of <1.69 have zero risk of death from COVID-19. In conclusion, we constructed artificial intelligence–based models to accurately predict the length of hospital stay and risk of death in COVID-19 cases. These smart models will arm physicians on the front line to enhance management strategies to save lives.

The effect of ABO blood group and antibody class on the risk of COVID-19 infection and severity of clinical outcomes

The COVID-19 pandemic has affected more than 100 million cases and caused immense burdens on governments and healthcare systems worldwide. Since its emergence in December 2019, research has been focused on treating the infected, identifying those at risk and preventing spread. There is currently no known biological biomarker that predicts the risk of infection. Several studies emerged suggesting an association between ABO blood group and the risk of COVID-19 infection. In this study, we used retrospective observational data in Bahrain to investigate the association between ABO blood group and risk of infection, as well as susceptibility to severe ICU-requiring infection. We found a higher risk associated with blood group B, and a lower risk with blood group AB. No association was observed between blood group and the risk of a severe ICU-requiring infection. We extended the analysis to study the association by antibodies; anti-a (blood groups B and O) and anti-b (blood groups A and O). No association between antibodies and both risk of infection or susceptibility to severe infection was found. The current study, along with the variation in blood group association results, indicates that blood group may not be an ideal biomarker to predict risk of COVID-19 infection.

Germline Genetic Variants of Viral Entry and Innate Immunity May Influence Susceptibility to SARS-CoV-2 Infection: Toward a Polygenic Risk Score for Risk Stratification

The ongoing COVID-19 pandemic caused by the novel coronavirus, SARS-CoV-2 has affected all aspects of human society with a special focus on healthcare. Although older patients with preexisting chronic illnesses are more prone to develop severe complications, younger, healthy individuals might also exhibit serious manifestations. Previous studies directed to detect genetic susceptibility factors for earlier epidemics have provided evidence of certain protective variations. Following SARS-CoV-2 exposure, viral entry into cells followed by recognition and response by the innate immunity are key determinants of COVID-19 development. In the present review our aim was to conduct a thorough review of the literature on the role of single nucleotide polymorphisms (SNPs) as key agents affecting the viral entry of SARS-CoV-2 and innate immunity. Several SNPs within the scope of our approach were found to alter susceptibility to various bacterial and viral infections. Additionally, a multitude of studies confirmed genetic associations between the analyzed genes and autoimmune diseases, underlining the versatile immune consequences of these variants. Based on confirmed associations it is highly plausible that the SNPs affecting viral entry and innate immunity might confer altered susceptibility to SARS-CoV-2 infection and its complex clinical consequences. Anticipating several COVID-19 genomic susceptibility loci based on the ongoing genome wide association studies, our review also proposes that a well-established polygenic risk score would be able to clinically leverage the acquired knowledge.

Association between ABO blood types and coronavirus disease 2019 (COVID-19), genetic associations, and underlying molecular mechanisms: a literature review of 23 studies

An association of various blood types and the 2019 novel coronavirus disease (COVID-19) has been found in a number of publications. The aim of this literature review is to summarize key findings related to ABO blood types and COVID-19 infection rate, symptom presentation, and outcome. Summarized findings include associations between ABO blood type and higher infection susceptibility, intubation duration, and severe outcomes, including death. The literature suggests that blood type O may serve as a protective factor, as individuals with blood type O are found COVID-19 positive at far lower rates. This could suggest that blood type O individuals are less susceptible to infection, or that they are asymptomatic at higher rates and therefore do not seek out testing. We also discuss genetic associations and potential molecular mechanisms that drive the relationship between blood type and COVID-19. Studies have found a strong association between a locus on a specific gene cluster on chromosome three (chr3p21.31) and outcome severity, such as respiratory failure. Cellular models have suggested an explanation for blood type modulation of infection, evidencing that spike protein/Angiotensin-converting enzyme 2 (ACE2)-dependent adhesion to ACE2-expressing cell lines was specifically inhibited by monoclonal or natural human anti-A antibodies, so individuals with non-A blood types, specifically O, or B blood types, which produce anti-A antibodies, may be less susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection due to the inhibitory effects of anti-A antibodies.

Prognostic Values of Serum Ferritin and D-Dimer Trajectory in Patients with COVID-19

Cytokine storm syndrome in patients with COVID-19 is mediated by pro-inflammatory cytokines resulting in acute lung injury and multiorgan failure. Elevation in serum ferritin and D-dimer is observed in COVID-19 patients. To determine prognostic values of optimal serum cutoff with trajectory plots for both serum ferritin and D-dimer in COVID-19 patients with invasive ventilator dependence and in-hospital mortality. We used retrospective longitudinal data from the Cerner COVID-19 de-identified cohort. COVID-19 infected patients with valid repeated values of serum ferritin and D-dimer during hospitalization were used in mixed-effects logistic-regression models. Among 52,411 patients, 28.5% (14,958) had valid serum ferritin and 28.6% (15,005) D-dimer laboratory results. Optimal cutoffs of ferritin (714 ng/mL) and D-dimer (2.1 mg/L) revealed AUCs ≥ 0.99 for in-hospital mortality. Optimal cutoffs for ferritin (502 ng/mL) and D-dimer (2.0 mg/L) revealed AUCs ≥ 0.99 for invasive ventilator dependence. Optimal cutoffs for in-house mortality, among females, were lower in serum ferritin (433 ng/mL) and D-dimer (1.9 mg/L) compared to males (740 ng/mL and 2.5 mg/L, respectively). Optimal cutoffs for invasive ventilator dependence, among females, were lower in ferritin (270 ng/mL) and D-dimer (1.3 mg/L) compared to males (860 ng/mL and 2.3 mg/L, respectively). Optimal prognostic cutoffs for serum ferritin and D-dimer require considering the entire trajectory of laboratory values during the disease course. Females have an overall lower optimal cutoff for both serum ferritin and D-dimer. The presented research allows health professionals to predict clinical outcomes and appropriate allocation of resources during the COVID-19 pandemic, especially early recognition of COVID-19 patients needing higher levels of care.

ABO blood group and COVID-19: a review on behalf of the ISBT COVID-19 working group

Growing evidence suggests that ABO blood group may play a role in the immunopathogenesis of SARS-CoV-2 infection, with group O individuals less likely to test positive and group A conferring a higher susceptibility to infection and propensity to severe disease. The level of evidence supporting an association between ABO type and SARS-CoV-2/COVID-19 ranges from small observational studies, to genome-wide-association-analyses and country-level meta-regression analyses. ABO blood group antigens are oligosaccharides expressed on red cells and other tissues (notably endothelium). There are several hypotheses to explain the differences in SARS-CoV-2 infection by ABO type. For example, anti-A and/or anti-B antibodies (e.g. present in group O individuals) could bind to corresponding antigens on the viral envelope and contribute to viral neutralization, thereby preventing target cell infection. The SARS-CoV-2 virus and SARS-CoV spike (S) proteins may be bound by anti-A isoagglutinins (e.g. present in group O and group B individuals), which may block interactions between virus and angiotensin-converting-enzyme-2-receptor, thereby preventing entry into lung epithelial cells. ABO type-associated variations in angiotensin-converting enzyme-1 activity and levels of von Willebrand factor (VWF) and factor VIII could also influence adverse outcomes, notably in group A individuals who express high VWF levels. In conclusion, group O may be associated with a lower risk of SARS-CoV-2 infection and group A may be associated with a higher risk of SARS-CoV-2 infection along with severe disease. However, prospective and mechanistic studies are needed to verify several of the proposed associations. Based on the strength of available studies, there are insufficient data for guiding policy in this regard.

ERAP1 and ERAP2 Enzymes: A Protective Shield for RAS against COVID-19?

Patients with coronavirus disease 2019 (COVID-19) have a wide variety of clinical outcomes ranging from asymptomatic to severe respiratory syndrome that can progress to life-threatening lung lesions. The identification of prognostic factors can help to improve the risk stratification of patients by promptly defining for each the most effective therapy to resolve the disease. The etiological agent causing COVID-19 is a new coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that enters cells via the ACE2 receptor. SARS-CoV-2 infection causes a reduction in ACE2 levels, leading to an imbalance in the renin-angiotensin system (RAS), and consequently, in blood pressure and systemic vascular resistance. ERAP1 and ERAP2 are two RAS regulators and key components of MHC class I antigen processing. Their polymorphisms have been associated with autoimmune and inflammatory conditions, hypertension, and cancer. Based on their involvement in the RAS, we believe that the dysfunctional status of ERAP1 and ERAP2 enzymes may exacerbate the effect of SARS-CoV-2 infection, aggravating the symptomatology and clinical outcome of the disease. In this review, we discuss this hypothesis.

COVID-19: Understanding Inter-Individual Variability and Implications for Precision Medicine

Coronavirus disease 2019 (COVID-19) is characterized by heterogeneity in susceptibility to the disease and severity of illness. Understanding inter-individual variation has important implications for not only allocation of resources but also targeting patients for escalation of care, inclusion in clinical trials, and individualized medical therapy including vaccination. In addition to geographic location and social vulnerability, there are clear biological differences such as age, sex, race, presence of comorbidities, underlying genetic variation, and differential immune response that contribute to variability in disease manifestation. These differences may have implications for precision medicine. Specific examples include the observation that androgens regulate the expression of the enzyme transmembrane protease, serine 2 which facilitates severe acute respiratory syndrome coronavirus 2 viral entry into the cell; therefore, androgen deprivation therapy is being explored as a treatment option in males infected with COVID-19. An immunophenotyping study of COVID-19 patients has shown that a subset develop T cytopenia which has prompted a clinical trial that is testing the efficacy of interleukin-7 in these patients. Predicting which COVID-19 patients will develop progressive disease that will require hospitalization has important implications for clinical trials that target outpatients. Enrollment of patients at low risk for progression of disease and hospitalization would likely not result in such therapy demonstrating efficacy. There are efforts to use artificial intelligence to integrate digital data from smartwatch applications or digital monitoring systems and biological data to enable identification of the high risk COVID-19 patient. The ultimate goal of precision medicine using such modern technology is to recognize individual differences to improve health for all.

Potential immuno-nanomedicine strategies to fight COVID-19 like pulmonary infections

COVID-19, coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a pandemic. At the time of writing this (October 14, 2020), more than 38.4 million people have become affected, and 1.0 million people have died across the world. The death rate is undoubtedly correlated with the cytokine storm and other pathological pulmonary characteristics, as a result of which the lungs cannot provide sufficient oxygen to the body's vital organs. While diversified drugs have been tested as a first line therapy, the complexity of fatal cases has not been reduced so far, and the world is looking for a treatment to combat the virus. However, to date, and despite such promise, we have received very limited information about the potential of nanomedicine to fight against COVID-19 or as an adjunct therapy in the treatment regimen. Over the past two decades, various therapeutic strategies, including direct-acting antiviral drugs, immunomodulators, a few non-specific drugs (simple to complex), have been explored to treat Acute Respiratory Distress Syndrome (ARDS), Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), influenza, and sometimes the common flu, thus, correlating and developing specific drugs centric to COVID-19 is possible. This review article focuses on the pulmonary pathology caused by SARS-CoV-2 and other viral pathogens, highlighting possible nanomedicine therapeutic strategies that should be further tested immediately.

Current understanding of the influence of environmental factors on SARS-CoV-2 transmission, persistence, and infectivity

Coronavirus disease 2019 (COVID-19) has emerged as a significant public health emergency in recent times. It is a respiratory illness caused by the novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was initially reported in late December 2019. In a span of 6 months, this pandemic spread across the globe leading to high morbidity and mortality rates. Soon after the identification of the causative virus, questions concerning the impact of environmental factors on the dissemination and transmission of the virus, its persistence in environmental matrices, and infectivity potential begin to emerge. As the environmental factors could have far-reaching consequences on infection dissemination and severity, it is essential to understand the linkage between these factors and the COVID-19 outbreak. In order to improve our current understanding over this topic, the present article summarizes topical and substantial observations made regarding the influences of abiotic environmental factors such as climate, temperature, humidity, wind speed, air, and water quality, solid surfaces/interfaces, frozen food, and biotic factors like age, sex, gender, blood type, population density, behavioural characteristics, etc. on the transmission, persistence, and infectivity of this newly recognized SARS-CoV-2 virus. Further, the potential pathways of virus transmission that could pose risk to population health have been discussed, and the critical areas have been identified which merits urgent research for the assessment and management of the COVID-19 outbreak. Where possible, the knowledge gaps requiring further investigation have been highlighted.

Pathogenesis of Multiple Organ Injury in COVID-19 and Potential Therapeutic Strategies

Severe acute respiratory disease coronavirus 2 (SARS-CoV-2, formerly 2019-nCoV) is a novel coronavirus that has rapidly disseminated worldwide, causing the coronavirus disease 2019 (COVID-19) pandemic. As of January 6th, 2021, there were over 86 million global confirmed cases, and the disease has claimed over 1.87 million lives (a ∼2.2% case fatality rate). SARS-CoV-2 is able to infect human cells by binding its spike (S) protein to angiotensin-conversing enzyme 2 (ACE2), which is expressed abundantly in several cell types and tissues. ACE2 has extensive biological activities as a component of the renin-angiotensin-aldosterone system (RAAS) and plays a pivotal role as counter-regulator of angiotensin II (Ang II) activity by converting the latter to Ang (1-7). Virion binding to ACE2 for host cell entry leads to internalization of both via endocytosis, as well as activation of ADAM17/TACE, resulting in downregulation of ACE2 and loss of its protective actions in the lungs and other organs. Although COVID-19 was initially described as a purely respiratory disease, it is now known that infected individuals can rapidly progress to a multiple organ dysfunction syndrome. In fact, all human structures that express ACE2 are susceptible to SARS-CoV-2 infection and/or to the downstream effects of reduced ACE2 levels, namely systemic inflammation and injury. In this review, we aim to summarize the major features of SARS-CoV-2 biology and the current understanding of COVID-19 pathogenesis, as well as its clinical repercussions in the lung, heart, kidney, bowel, liver, and brain. We also highlight potential therapeutic targets and current global efforts to identify safe and effective therapies against this life-threatening condition.