Association of ABO blood groups with presentation and outcomes of confirmed SARS CoV-2 infection: A prospective study in the largest COVID-19 dedicated hospital in Bangladesh

Abstract

Background Globally, studies have shown conflicting results regarding the association of blood groups with SARS CoV-2 infection. Objective To observe the association between ABO blood groups and the presentation and outcomes of confirmed COVID-19 cases. Design, setting, and participants This was a prospective cohort study of patients with mild-to-moderately severe COVID-19 infections who presented in the COVID-19 unit of Dhaka Medical College Hospital and were enrolled between 01 June and 25 August, 2020. Patients were followed up for at least 30 days after disease onset. We grouped participants with A-positive and A-negative blood groups into group I and participants with other blood groups into group II. Results The cohort included 438 patients; 52 patients were lost to follow-up, five died, and 381 completed the study. The prevalence of blood group A [144 (32.9%)] was significantly higher among COVID-19 patients than in the general population (p < 0.001). The presenting age [mean (SD)] of group I [42.1 (14.5)] was higher than that of group II [38.8 (12.4), p = 0.014]. Sex (p = 0.23) and co-morbidity (hypertension, p = 0.34; diabetes, p = 0.13) did not differ between the patients in groups I and II. No differences were observed regarding important presenting symptoms, including fever (p = 0.72), cough (p = 0.69), and respiratory distress (p = 0.09). There was no significant difference in the median duration of symptoms in the two group (12 days), and conversion to the next level of severity was observed in 26 (20.6%) and 36 patients (13.8%) in group I and II, respectively. However, persistent positivity of RT-PCR at 14 days of initial positivity was more frequent among the patients in group I [24 (19%)] than among those in group II [29 (11.1%)]. Conclusions The prevalence of blood group A was higher among COVID-19 patients. Although ABO blood groups were not associated with the presentation or recovery period of COVID-19, patients with blood group A had delayed seroconversion.

Association of ABO blood group with COVID-19 severity, acute phase reactants and mortality

“…Blood group A was prevalent in their population (42.8%) and it was statistically associated with increased infection risk of COVID-19 (OR: 1.33, 95% CI: 1.02-1.73, p=0.04) in their female population [11]. Two recent studies from the subcontinent: one from Peshawar, Pakistan, and the other from Dhaka, Bangladesh have demonstrated the susceptibility of COVID-19 with the ABO blood groups [12,13]. The study from Pakistan had a sample size of 1935 patients, with blood group B as the prevalent blood type (35.9%) with an increased susceptibility for COVID-19 infection (OR: 1.195 (95% CI: 1.04-1.36), p=0.009) while blood groups A and O did not have statistically significant association of positive RT-PCR for SARS-COV-2.…”

Are ABO Gene Alleles Responsible for Cardiovascular Diseases and Venous Thromboembolism and Do They Play a Role in COVID?

“…A single-centre study from Bangladesh which evaluated 438 patients with SARS-CoV-2 infection also found a significantly higher rate of blood group A amongst COVID-19 patients compared to the general population [20]. However, ABO blood groups were not associated with type of presentation or recovery from infection [20]. Conversely, an observational study of 14,112 individuals tested for SARS-CoV-2 in the New York Presbyterian hospital system found that risk of intubation was increased for AB and B blood groups but decreased for A when compared to O blood group and risk of death was increased for those with AB blood group and decreased for A and B blood groups [19].…”

“…A single-centre study from Bangladesh which evaluated 438 patients with SARS-CoV-2 infection also found a significantly higher rate of blood group A amongst COVID-19 patients compared to the general population [20]. However, ABO blood groups were not associated with type of presentation or recovery from infection [20].…”

“…There is growing evidence that ABO blood groups may play a role in the susceptibility to and severity of SARS-CoV-2 infection [18][19][20]. Individuals with blood group O have a lower risk and those with blood group A carry a higher risk of SARS-CoV-2 infection [18].…”

“…Postulated mechanisms include an increase in angiotensin converting enzyme-1 levels in blood group A patients and an increased risk of cardiovascular, thromboembolic, and inflammatory complications [18]. It is plausible that possession of a non-O blood group and associated increase in vWF and factor VIII levels have an additive effect to the thrombophilia caused by SARS-CoV-2 and results in an increased risk of COVID-related CVD complications [18][19][20]. A recent hypothesis for an association between non-O blood group type and risk of SARS-CoV-2 infection is that anti-A and/or anti-B antibodies, which are present in patients with blood group O bind to a corresponding antigen, for example the angiotensin-converting-enzyme-2-receptor, on the SARS-CoV-2 viral envelope which then inhibits viral entry into lung epithelium (Figure 4) [18].…”