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      Testing the association between blood type and COVID-19 infection, intubation, and death

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      medRxiv

      Cold Spring Harbor Laboratory

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          Abstract

          The rapid global spread of the novel coronavirus SARS-CoV-2 has strained existing healthcare and testing resources, making the identification and prioritization of individuals most at-risk a critical challenge. A recent study of patients in China discovered an association between ABO blood type and SARS-CoV-2 infection status by comparing COVID-19 patients with the general population. Whether blood type is associated with increased COVID-19 morbidity or mortality remains unknown. We used observational healthcare data on 1559 individuals tested for SARS-CoV-2 (682 COV+) with known blood type in the New York Presbyterian (NYP) hospital system to assess the association between ABO+Rh blood type and SARS-CoV-2 infection status, intubation, and death. We found a higher proportion of blood group A and a lower proportion of blood group O among COV+ patients compared to COV−, though in both cases the result is significant only in Rh positive blood types. We show that the effect of blood type is not explained by risk factors we considered (age, sex, hypertension, diabetes mellitus, overweight status, and chronic cardiovascular and lung disorders). In a meta-analysis of NYP data with previously-reported data from China, we find enrichment for A and B and depletion of O blood groups among COVID-19 patients compared to the general population. Our data do not provide strong evidence of associations between blood group and intubation or death among COVID-19 patients. In this preliminary observational study of data currently being collected during the outbreak, we find new evidence of associations between B, AB, and Rh blood groups and COVID-19 and further evidence of recently-discovered associations between A and O blood groups and COVID-19.

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            Attachment of Helicobacter pylori to human gastric epithelium mediated by blood group antigens.

            Helicobacter pylori is associated with development of gastritis, gastric ulcers, and adenocarcinomas in humans. The Lewis(b) (Le(b)) blood group antigen mediates H. pylori attachment to human gastric mucosa. Soluble glycoproteins presenting the Leb antigen or antibodies to the Leb antigen inhibited bacterial binding. Gastric tissue lacking Leb expression did not bind H. pylori. Bacteria did not bind to Leb antigen substituted with a terminal GalNAc alpha 1-3 residue (blood group A determinant), suggesting that the availability of H. pylori receptors might be reduced in individuals of blood group A and B phenotypes, as compared with blood group O individuals.
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              Relationship between the ABO Blood Group and the COVID-19 Susceptibility

              OBJECTIVE To investigate the relationship between the ABO blood group and the COVID-19 susceptibility. DESIGN The study was conducted by comparing the blood group distribution in 2,173 patients with COVID-19 confirmed by SARS-CoV-2 test from three hospitals in Wuhan and Shenzhen, China with that in normal people from the corresponding regions. Data were analyzed using one-way ANOVA and 2-tailed χ2 and a meta-analysis was performed by random effects models. SETTING Three tertiary hospitals in Wuhan and Shenzhen, China. PARTICIPANTS A total of 1,775 patients with COVID-19, including 206 dead cases, from Wuhan Jinyintan Hospital, Wuhan, China were recruited. Another 113 and 285 patients with COVID-19 were respectively recruited from Renmin Hospital of Wuhan University, Wuhan and Shenzhen Third People's Hospital, Shenzhen, China. MAIN OUTCOME MEASURES Detection of ABO blood groups, infection occurrence of SARS-CoV-2, and patient death RESULTS The ABO group in 3694 normal people in Wuhan showed a distribution of 32.16%, 24.90%, 9.10% and 33.84% for A, B, AB and O, respectively, versus the distribution of 37.75%, 26.42%, 10.03% and 25.80% for A, B, AB and O, respectively, in 1775 COVID-19 patients from Wuhan Jinyintan Hospital. The proportion of blood group A and O in COVID-19 patients were significantly higher and lower, respectively, than that in normal people (both P < 0.001). Similar ABO distribution pattern was observed in 398 patients from another two hospitals in Wuhan and Shenzhen. Meta-analyses on the pooled data showed that blood group A had a significantly higher risk for COVID-19 (odds ratio-OR, 1.20; 95% confidence interval-CI 1.02~1.43, P = 0.02) compared with non-A blood groups, whereas blood group O had a significantly lower risk for the infectious disease (OR, 0.67; 95% CI 0.60~0.75, P < 0.001) compared with non-O blood groups.In addition, the influence of age and gender on the ABO blood group distribution in patients with COVID-19 from two Wuhan hospitals (1,888 patients) were analyzed and found that age and gender do not have much effect on the distribution. CONCLUSION People with blood group A have a significantly higher risk for acquiring COVID-19 compared with non-A blood groups, whereas blood group O has a significantly lower risk for the infection compared with non-O blood groups.
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                Author and article information

                Contributors
                Journal
                medRxiv
                MEDRXIV
                medRxiv
                Cold Spring Harbor Laboratory
                11 April 2020
                Affiliations
                Department of Biomedical Informatics, Columbia University Irving Medical Center, Funded by NIH T15 LM007079
                Department of Biomedical Informatics, Columbia University Irving Medical Center;
                Department of Systems Biology, Columbia University Irving Medical Center;
                Department of Medicine, Columbia University Irving Medical Center;
                Institute for Genomic Medicine, Columbia University Irving Medical Center
                Author notes
                [† — ]Corresponding author: nick.tatonetti@ 123456columbia.edu (Nicholas P. Tatonetti)
                Article
                10.1101/2020.04.08.20058073
                7276013
                32511586
                5e0782da-1488-43a5-814c-3e751d6459d1

                It is made available under a CC-BY 4.0 International license.

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