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

Abstract

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.

Factors related to the development of high antibody titres against SARS‐CoV‐2 in convalescent plasma donors from the ConPlas‐19 trial

“…Male donors were a median of 4 years older than female donors (42.0 vs. 37.9; p = 0.003). The distribution of donors' ABO blood type matched that of the Spanish population [14]: 44.6% group A, 39.4% group O, 8.8% group B and 7.2% group AB, with the commonest types being A positive (36.8%) and O positive (33.2%). Donors' COVID‐19 diagnosis was confirmed by RT‐PCR in 292 cases (73%).…”

“…Donors' COVID-19 severity was not recorded in the study protocol. Their median duration of symptoms of SARS-CoV-2 infection was 13 days (IQR [7][8][9][10][11][12][13][14][15][16][17][18][19], and it increased with donor age at a rate of 0.17 days for each year increase in donor age (95% CI, 0.09-0.25; p < 0.001). We did not find an association between symptom duration and donor sex or ABO blood type.…”

The impact of ABO blood types on humoral immunity responses and antibody persistency after different COVID‐19 vaccine regimens

“…Blood group O individuals in Iraq were found to be less likely to develop SARS‐CoV‐2 than non‐O participants, while A type carriers showed a higher risk of infection 20 . The other investigation in Spain also showed that patients with blood group O presented a significantly lower risk for SARS‐CoV‐2 infection and hospitalization 21 . Furthermore, different studies found that subjects with Rh‐negative blood type were at lower risk of SARS‐CoV‐2 infection, severe form of the disease and mortality 11,16,22 .…”

“…20 The other investigation in Spain also showed that patients with blood group O presented a significantly lower risk for SARS-CoV-2 infection and hospitalization. 21 Furthermore, different studies found that subjects with Rh-negative blood type were at lower risk of SARS-CoV-2 infection, severe form of the disease and mortality. 11,16,22 In the context of the demonstrated data, ABOassociated differences in COVID-19 infection outcomes were explored in the present study as well as the humoral response to COVID-19 vaccine and long-term safety.…”

ABO Blood Group and Bleeding and Survival in VA-ECMO Patients

“…A 2018 study reported a higher mortality rate in severe trauma patients with O type blood compared to non-O peers, but did not show significantly increased RBC requirements within the first 24 hours after arrival to the emergency room. 3 More recently, the relationship between ABO blood group and influence on COVID-19 susceptibility and outcomes has piqued the interest of the scientific community, with observational studies concluding that the odds for COVID-19 infection were significantly increased for blood group A and decreased for blood group O, 17,18 reinforcing the idea that ABO phenotypes may affect a multitude of physiologic processes including innate immunity. In the cardiac surgical setting, the relationship between blood group and bleeding has been studied in several different populations, with conflicting results-several smallscale studies of LVAD patients have failed to demonstrate a difference in bleeding rates between O and non-O groups, [19][20][21] whereas Welsby et al found that in CABG patients, O blood group did not have increased blood loss and instead required fewer RBC transfusions intraoperatively compared to their non-O peers.…”