Blood Res.  2023 Sep;58(3):138-144. 10.5045/br.2023.2023122.

ABO blood group and rhesus factor association with inpatient COVID-19 mortality and severity: a two-year retrospective review

• Phan AT
• Ucar AA
• Malkoc A
• Hu J
• Buxton L
• Tseng AW
• Dong F
• Nguyễn ,JP
• Modi AP
• Deshpande O
• Lay J
• Ku A
• Ogunyemi D
• Arabian S

• KMID: 2546315
• DOI: http://doi.org/10.5045/br.2023.2023122

Abstract

Background
Early reports have indicated a relationship between ABO and rhesus blood group types and infection with SARS-CoV-2. We aim to examine blood group type associations with COVID-19 mortality and disease severity.
Methods
This is a retrospective chart review of patients ages 18 years or older admitted to the hospital with COVID-19 between January 2020 and December 2021. The primary outcome was COVID-19 mortality with respect to ABO blood group type. The secondary outcomes were 1. Severity of COVID-19 with respect to ABO blood group type, and 2. Rhesus factor association with COVID-19 mortality and disease severity. Disease severity was defined by degree of supplemental oxygen requirements (ambient air, low-flow, high-flow, non-invasive mechanical ventilation, and invasive mechanical ventilation).
Results
The blood type was collected on 596 patients with more than half (54%, N=322) being O+. The ABO blood type alone was not statistically associated with mortality (P=0.405), while the RH blood type was statistically associated with mortality (P＜0.001). There was statistically significant association between combined ABO and RH blood type and mortality (P=0.014). Out of the mortality group, the O+ group had the highest mortality (52.3%), followed by A+ (22.8%). The combined ABO and RH blood type was statistically significantly associated with degree of supplemental oxygen requirements (P =0.005). The Kaplan-Meier curve demonstrated that Rh- patients had increased mortality.
Conclusion
ABO blood type is not associated with COVID-19 severity and mortality. Rhesus factor status is associated with COVID-19 severity and mortality. Rhesus negative patients were associated with increased mortality risk.

Keyword

COVID-19; Infectious disease; Pulmonary medicine; Mechanical ventilation; SARS-CoV-2

Figure

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  Fig. 1 Consort diagram detailing the selection of patients with COVID-19 and their respective blood types.

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  Fig. 2 Histogram of patient mortality separated by combined ABO and Rh blood type. Green bars indicate the number of patients who were alive, which are separated by blood group types. Purple bars indicate the number of patients who died, which are separated by blood group types.

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  Fig. 3 Kaplan-Meier survival probability based on RH status demonstrating higher risk of mortality for RH-patients where seven-day mortality risk for Rh-patients was 42% while seven-day mortality risk for Rh+ patients was 37% (P=0.025).

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