The association of ABO blood group with indices of disease severity and multiorgan dysfunction in COVID-19

Abstract

Studies on severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) suggest a protective effect of anti-A antibodies against viral cell entry that may hold relevance for SARS-CoV-2 infection. Therefore, we aimed to determine whether ABO blood groups are associated with different severities of COVID-19. We conducted a multicenter retrospective analysis and nested prospective observational substudy of critically ill patients with COVID-19. We collected data pertaining to age, sex, comorbidities, dates of symptom onset, hospital admission, intensive care unit (ICU) admission, mechanical ventilation, continuous renal replacement therapy (CRRT), standard laboratory parameters, and serum inflammatory cytokines. National (N = 398 671; P = .38) and provincial (n = 62 246; P = .60) ABO blood group distributions did not differ from our cohort (n = 95). A higher proportion of COVID-19 patients with blood group A or AB required mechanical ventilation (P = .02) and CRRT (P = .004) and had a longer ICU stay (P = .03) compared with patients with blood group O or B. Blood group A or AB also had an increased probability of requiring mechanical ventilation and CRRT after adjusting for age, sex, and presence of ≥1 comorbidity. Inflammatory cytokines did not differ between patients with blood group A or AB (n = 11) vs O or B (n = 14; P > .10 for all cytokines). Collectively, our data indicate that critically ill COVID-19 patients with blood group A or AB are at increased risk for requiring mechanical ventilation, CRRT, and prolonged ICU admission compared with patients with blood group O or B. Further work is needed to understand the underlying mechanisms.

Chromosome 3 cluster rs11385942 variant links complement activation with severe COVID-19

“…In parallel, we examined the impact of ABO blood group, as group O was associated with reduced risk of COVID-19, whereas the protection towards more severe outcomes in hospitalized patients is still disputed and may be modulated by genetic modifiers [ 11 , 12 , [18] , [19] , [20] ]. Interestingly, we found that group O is associated with reduced C5a and SC5b-9 levels, but only C5a reached statistical significance.…”

“…Furthermore, ABO blood group was involved in the susceptibility to COVID-19, with carriage of blood O conferring modest protection. Again a sound mechanistic explanation for such association was not yet reported [ 11 , 12 , [18] , [19] , [20] ].…”

Association between ABO blood groups and susceptibility to COVID-19: profile of age and gender in Iraqi patients

“…In a study from China (Wuhan city), the frequency of group A was significantly increased in COVID-19 patients compared to controls, while groups B, AB, and O frequencies showed no significant differences [9].. A Spanish study suggested a lower susceptibility to COVID-19 for group O, while a higher risk of complications was found in group B patients [13]. Canadian data indicated that group A or AB was associated with critical illness of COVID-19 compared to group O or B [38]. In a previous Iraqi study conducted by our group, susceptibility to COVID-19 was associated with group AB in patients from Baghdad, while group A was associated with an increased risk of death [20].…”

The Impact of ABO Blood Grouping on COVID-19 Vulnerability and Seriousness: A Retrospective Cross-Sectional Controlled Study among the Arab Community

“…This study's findings contradict the studies carried in Italy and Spain (patients with blood group A+ were at a high risk of respiratory failure while those with blood type O were protected) [15], Spain (group A patients had a high mortality risk, group O patients a low mortality) [16], France (blood group A patients had a high risk of both infection and severe course) [19], Canada (patients with blood groups A and AB showed more severe illness) [21], Turkey (blood group A patients had higher risk, group O patients had lower risk, and ABO does not affect the severity) [23], China (blood group A patients are had high risk of severity and blood group O patients had low) [24], China (blood group A patients had a high risk of infection) [25], USA, and Denmark (no association between ABO, infection, and severity) [26,27], Iraq (blood group A patients are at increased risk of both infection and severity) [28], and India (blood group O patients have decreased mortality; blood group B patients increased mortality) [29].…”