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

Blood-Type-A is a COVID-19 infection and hospitalization risk in a Turkish cohort

We have shown in an ethnically homogenous Turkey cohort with more than six thousand cases and 25 thousand controls that ABO blood types that contain anti-A antibody (O and B) are protective against COVID-19 infection and hospitalization, whereas those without the anti-A antibody (A and AB) are risks. The A + AB frequency increases from 54.7 % in uninfected controls to 57.6 % in COVID-19 outpatients, and to 62.5 % in COVID-19 inpatients. The odds-ratio (OR) for lacking of anti-A antibody risk for infection is 1.16 (95 % confidence interval (CI) 1.1-1.22, and Fisher test p-value 1.8 × 10^-7). The OR for hospitalization is 1.23 (95 %CI 1.06-1.42, Fisher test p-value 0.005). A linear regression treating controls, outpatients, inpatients as three numerical levels over anti-A antibody leads to a p-value of 5.9 × 10^-9. All these associations remain to be statistically significant after conditioning over age, even though age itself is a risk for both infection and hospitalization. We also attempted to correct the potential effect from vaccination, even though vaccination information is not available, by using the date of the data collection as a surrogate to vaccination status. Although no significant association between infection/hospitalization with Rhesus blood system was found, forest plots are used to illustrate possible trends.

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.

ABO blood group and link to COVID-19: A comprehensive review of the reported associations and their possible underlying mechanisms

ABO blood group is long known to be an influencing factor for the susceptibility to infectious diseases, and many studies have been describing associations between ABO blood types and COVID-19 infection and severity, with conflicting findings. This narrative review aims to summarize the literature regarding associations between the ABO blood group and COVID-19. Blood type O is mostly associated with lower rates of SARS-CoV-2 infection, while blood type A is frequently described as a risk factor. Although results regarding the risk of severe outcomes are more variable, blood type A is the most associated with COVID-19 severity and mortality, while many studies describe O blood type as a protective factor for the disease progression. Furthermore, genetic associations with both the risk of infection and disease severity have been reported for the ABO locus. Some underlying mechanisms have been hypothesized to explain the reported associations, with incipient experimental data. Three major hypotheses emerge: SARS-CoV-2 could carry ABO(H)-like structures in its envelope glycoproteins and would be asymmetrically transmitted due to a protective effect of the ABO antibodies, ABH antigens could facilitate SARS-CoV-2 interaction with the host’ cells, and the association of non-O blood types with higher risks of thromboembolic events could confer COVID-19 patients with blood type O a lower risk of severe outcomes. The hypothesized mechanisms would affect distinct aspects of the COVID-19 natural history, with distinct potential implications to the disease transmission and its management.

Influence of Coronavirus Disease 2019 on some Physiological Blood Parameters in Patients with Kidney Failure in Iraq

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a novel coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2; SARS-CoV-2), which is related to the SARS-CoV-2 and the Middle East Respiratory Syndrome Coronavirus, which caused serious outbreaks in 2003 and 2012. This study aimed to determine if there is an association between ABO blood types/renal failure and infection with COVID-19. Furthermore, the effects of COVID-19 infection on some blood parameters and electrolyte levels were investigated in this study. In the current study, 90 samples were obtained from males and females aged between 21-68 years old. The data were collected from September to February 2021 in a Kidney Center of Alsaader Teaching Hospital. The participants were divided into three groups (n=30) of A) kidney failure, B) kidney failure with COVID-19, and C) kidney failure with COVID-19 recovery after one month. The variables of this study included blood group types, blood electrolytes, and some blood biochemical parameters. According to the results, regarding the frequency of blood groups, in the control group, 34, 20, 14, and 36 participants belonged to the A , B, AB, and O blood groups, respectively. The recorded data showed that participants who had suffered from kidney failure and were infected with COVID-19 belonged to the A, B, AB, and O blood groups (25%, 10%, 27%, and 45%), respectively, while kidney failure patients who had recovered after one month from COVID-19 had blood groups of A, B, AB, and O (25%, 22%, 105%, and 45%, respectively). The recorded data showed a significant decrease (P<0.05) in the levels of Potassium (K), Sodium (Na), and Calcium (Ca) in the B group, compared to the A group, while the levels of K, Na, and Ca had significantly improved in group C (P<0.05), compared to group B. The Chloride level showed no significant differences among the groups. Furthermore, non-significant differences (P>0.05) were observed in the red blood cells (RBC), hemoglobin (Hb), and white blood cell count (WBC) in the COVID-19 group (Group B), compared to group A; however, there was a significant raise (P<0.05) in WBC and platelet (PLT), as well as a significant decrease (P<0.05) in lymphocyte (LYM), RBC, Hb, and hematocrit (HCT) in group C, compared to groups A and B. In conclusion, blood group O obtained the lowest level of resistance to COVID-19, compared to blood group A which had the highest response to recovery. The COVID-19 patients with kidney failure showed a significant decrease in blood parameters, such as RBCs, Hb, LYM, PLT, HCT, and electrolytes.

The relationship between blood groups and risk of infection with SARS-CoV-2 or development of severe outcomes: A review

The outbreak of coronavirus disease 2019 (COVID‐19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is considered a global catastrophe that has overwhelmed health care systems. Since initiation of the pandemic, identification of characteristics that might influence risk of infection and poor disease outcomes have been of paramount interest. Blood group phenotypes are genetically inherited characteristics whose association with certain infectious diseases have long been debated. The aim of this review is to identify whether a certain type of blood group may influence an individual’s susceptibility to SARS‐CoV‐2 infection and developing severe outcomes. Our review shows that blood group O protects individuals against SARS‐CoV‐2, whereas blood group A predisposes them to being infected. Although the association between blood groups and outcomes of COVID‐19 is not consistent, it is speculated that non‐O blood group carriers with COVID‐19 are at higher risk of developing severe outcomes in comparison to O blood group. The interaction between blood groups and SARS‐CoV‐2 infection is hypothesized to be as result of natural antibodies against blood group antigens that may act as a part of innate immune response to neutralize viral particles. Alternatively, blood group antigens could serve as additional receptors for the virus and individuals who are capable of expressing these antigens on epithelial cells, which are known as secretors, would then have a high propensity to be affected by SARS‐CoV‐2.

COVID-19 coagulopathies: Human blood proteins mimic SARS-CoV-2 virus, vaccine proteins and bacterial co-infections inducing autoimmunity: Combinations of bacteria and SARS-CoV-2 synergize to induce autoantibodies targeting cardiolipin, cardiolipin-binding proteins, platelet factor 4, prothrombin, and coagulation factors

Severe COVID-19 is often accompanied by coagulopathies such as thrombocytopenia and abnormal clotting. Rarely, such complications follow SARS-CoV-2 vaccination. The cause of these coagulopathies is unknown. It is hypothesized that coagulopathies accompanying SARS-CoV-2 infections and vaccinations result from bacterial co-infections that synergize with virus-induced autoimmunity due to antigenic mimicry of blood proteins by both bacterial and viral antigens. Coagulopathies occur mainly in severe COVID-19 characterized by bacterial co-infections with Streptococci, Staphylococci, Klebsiella, Escherichia coli, and Acinetobacter baumannii. These bacteria express unusually large numbers of antigens mimicking human blood antigens, as do both SARS-CoV-2 and adenoviruses. Bacteria mimic cardiolipin, prothrombin, albumin, and platelet factor 4 (PF4). SARS-CoV-2 mimics complement factors, Rh antigens, platelet phosphodiesterases, Factors IX and X, von Willebrand Factor (VWF), and VWF protease ADAMTS13. Adenoviruses mimic prothrombin and platelet factor 4. Bacterial prophylaxis, avoidance of vaccinating bacterially infected individuals, and antigen deletion for vaccines may reduce coagulopathy risk. Also see the video abstract here: https://youtu.be/zWDOsghrPg8.

Early high-titer convalescent plasma therapy in patients with moderate and severe COVID-19

BACKGROUND AND OBJECTIVES

The use of COVID-19 convalescent plasma (CCP) has been approved by the FDA. We assessed the outcome of patients with moderate and severe COVID-19 following convalescent plasma therapy and the association with variables such as antibody titer in CCP units and transfusion time.

MATERIALS AND METHODS

In this prospective cohort study, 3097 patients with moderate and severe COVID-19 (according to WHO Progression Scale) had heterogeneous demographic and clinical characteristics received plasma with an unknown titer at the transfusion time. Firstly, information about age, sex, blood group, the time interval from hospitalization to CCP transfusion, underlying disease, and antibody titer with the outcome were investigated. Then, multivariate logistic regression and area under the curve (AUC) were performed for the association between disease severity and intubation variables with transfusion time and outcome.

RESULTS

Patients with younger age receiving CCP in the first five days of hospitalization had lower mortality (P < 0.0001). Moreover, patients without the underlying disease had lower mortality (P < 0.001). The mortality rate also decreased in severe patients who were intubated receiving CCP for less than five days (P < 0.001). In patients with moderate severity (score less than 5) who received IgG antibody levels above 1:320 in less than five days had lower mortality (P < 0.0001).

CONCLUSION

Our findings suggested that COVID-19 patients with the moderate type of disease receiving CCP units with high antibody titers in the early stages of the disease experienced greater effectiveness of CCP therapy.

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.

An AHP-based regional COVID-19 vulnerability model and its application in China

Since the COVID-19 outbreak, four cities-Wuhan, Beijing, Urumqi and Dalian-have experienced the process from outbreak to stabilization. According to the China Statistical Yearbook and China Center for Disease Control records, regional, pathological, medical and response attributes were selected as regional vulnerability factors of infectious diseases. Then the Analytic Hierarchy Process (AHP) method was used to build a regional vulnerability index model for the infectious disease. The influence of the COVID-19 outbreak at a certain place was assessed computationally in terms of the number of days of epidemic duration and cumulative number of infections, and then fitted to the city data. The resulting correlation coefficient was 0.999952. The range of the regional vulnerability index for COVID-19 virus was from 0.0513 to 0.9379. The vulnerability indexes of Wuhan, Urumqi, Beijing and Dalian were 0.8733, 0.1951, 0.1566 and 0.1119, respectively. The lack of understanding of the virus became the biggest breakthrough point for the rapid spread of the virus in Wuhan. Due to inadequate prevention and control measures, the city of Urumqi was unable to trace the source of infection and close contacts, resulting in a relatively large impact. Beijing has both high population density and migration rate, which imply that the disease outbreak in this city had a great impact. Dalian has perfect prevention and good regional attributes. In addition, the regional vulnerability index model was used to analyze other Chinese cities. Accordingly, the regional vulnerability index and the prevention and control suggestions for them were discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40808-021-01244-y.