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.

Conventional Amphotericin B Associated Nephrotoxicity in Patients With Hematologic Malignancies

Introduction: Amphotericin B (AmB-d) is one of the most effective therapeutic options against frequently life-threatening systemic fungal infections in patients with hematologic malignancies. However, significant adverse effects including nephrotoxicity associated with its use limit its more widespread use. The objectives of our study were to determine the incidence of AmB-d associated nephrotoxicity, to evaluate clinical and epidemiological characteristics of patients, and to support the notion that conventional amphotericin B remains a valid therapeutic option among hematologic patients with proper patient selection.

Materials and methods: A total of 110 patients with hematologic malignancies were admitted to our Hematology Unit between January 2014 and November 2017 who required anti-fungal therapy during intensive systemic chemotherapy. The incidence of AmB-d associated nephrotoxicity, side effect profile, time to nephrotoxicity, and clinical and epidemiological characteristics associated with treatment success were assessed retrospectively.

Results: Of the 110 patients receiving AmB-d, 70 (63.6%) were male and 40 (36.4%) were female. The mean age of participants was 44 years. The most common diagnosis was acute myeloid leukemia (n=53, 48.2%), and the most common chemotherapy protocol was 7 + 3 remission-induction (cytarabine 100 mg/m² days 1-7, Idarubicin 12 mg/m² days 1-3; n=24, 21.8%). In 56.4% of the patients, antifungal therapy was given empirically. In 40 patients (36.4%), nephrotoxicity was observed following antifungal treatment, and only four patients had stage 3 renal failure. The mean duration of time to nephrotoxicity from initiation of amphotericin B was four days (min: 2, max: 31). All patients were found to receive at least one additional potential nephrotoxic treatment during the antifungal treatment process. 

Conclusion: AmB-d is associated with a significant risk of nephrotoxicity. In most hematological patients, antifungal treatment is initiated empirically, and patients received prolonged courses of treatment. Therefore, it is plausible to initiate such treatment with AmB-d, when one considers the already high treatment costs in this patient group as well as the fact that AmB-d offers similar efficacy to antifungal agents at a lower cost. AmB-d may be recommended as a first-line agent in this patient group with the introduction of newer and more costly antifungal agents when needed, on the basis of the fact that these patients can be closely monitored in a hospital setting, reversible nature of nephrotoxicity upon discontinuation, and rare occurrence of severe renal failure requiring dialysis.