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Observational Study
. 2024 Mar;204(3):826-838.
doi: 10.1111/bjh.19234. Epub 2023 Nov 27.

Association of ABO and Rhesus blood groups with severe outcomes from non-SARS-CoV-2 respiratory infection: A prospective observational cohort study in Bristol, UK 2020-2022

Alice Hathaway  1 , George Qian  2 , Jade King  3 , Serena McGuinness  4 , Nick Maskell  5 , Jennifer Oliver  4 , Adam Finn  6 , Leon Danon  2 , Robert Challen  2 , Ashley M Toye  1 , Catherine Hyams  6   7 ; Avon CAP Research Group
Collaborators, Affiliations
Observational Study

Association of ABO and Rhesus blood groups with severe outcomes from non-SARS-CoV-2 respiratory infection: A prospective observational cohort study in Bristol, UK 2020-2022

Alice Hathaway et al. Br J Haematol. 2024 Mar.

Abstract

Despite significant global morbidity associated with respiratory infection, there is a paucity of data examining the association between severity of non-SARS-CoV-2 respiratory infection and blood group. We analysed a prospective cohort of adults hospitalised in Bristol, UK, from 1 August 2020 to 31 July 2022, including patients with acute respiratory infection (pneumonia [n = 1934] and non-pneumonic lower respiratory tract infection [NP-LRTI] [n = 1184]), a negative SARS-CoV-2 test and known blood group status. The likelihood of cardiovascular complication, survival and hospital admission length was assessed using regression models with group O and RhD-negative status as reference groups. Group A and RhD-positive were over-represented in both pneumonia and NP-LRTI compared to a first-time donor population (p < 0.05 in all); contrastingly, group O was under-represented. ABO group did not influence cardiovascular complication risk; however, RhD-positive patients with pneumonia had a reduced odds ratio (OR) for cardiovascular complications (OR = 0.77 [95% CI = 0.59-0.98]). Compared to group O, group A individuals with NP-LRTI were more likely to be discharged within 60 days (hazard ratio [HR] = 1.17 [95% CI = 1.03-1.33]), while group B with pneumonia was less likely (HR = 0.8 [95% CI = 0.66-0.96]). This analysis provides some evidence that blood group status may influence clinical outcome following respiratory infection, with group A having increased risk of hospitalisation and RhD-positive patients having reduced cardiovascular complications.

Keywords: blood group; pneumonia; respiratory infection.

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Conflict of interest statement

CH is Principal Investigator of the AvonCAP study which is an investigator-led University of Bristol study funded by Pfizer and has previously received support from the NIHR in an Academic Clinical Fellowship. JO is a Co-Investigator on the AvonCAP Study. LD is further supported by UKRI through the JUNIPER consortium (grant number MR/V038613/1), MRC (grant number MC/PC/19067), EPSRC (EP/V051555/1 and The Alan Turing Institute, grant EP/N510129/1). AF is a member of the UK Joint Committee on Vaccination and Immunization (JCVI) and chair of the World Health Organization European Technical Advisory Group of Experts on Immunization (ETAGE) committee. In addition to receiving funding from Pfizer as Chief Investigator of this study, he leads another project investigating transmission of respiratory bacteria in families jointly funded by Pfizer and the Gates Foundation and is an investigator in trials of COVID-19 vaccines including ChAdOx1nCOV-19, Janssen and Valneva vaccines. The other authors have no relevant conflicts of interest to declare. The AvonCAP study is a University of Bristol sponsored study which is investigator-led and funded under a collaborative agreement by Pfizer Inc.

Figures

Figure One
Figure One. Study Flow Diagram
Of the 20,614 episodes of adults hospitalised with aLRTD during the study period, there were 3,118 admissions with SARS-CoV-2 negative respiratory infection in patients with a known blood group: 1,934 with pneumonia and 1,184 admissions with NP-LRTI. aLRTD, acute lower respiratory tract disease; NP-LRTI, non-pneumonia lower respiratory tract infection
Figure Two
Figure Two. Hospital Admission and Clinical Outcome Patient Distributions by Blood Group
Respiratory infection, pneumonia and NP-LRTI multinominal exact goodness of fit plots against (A) ABO blood group alone (B) ABO blood group and Rhesus group (C) Rhesus group alone. Respiratory infection, pneumonia and NP-LRTI multinomial exact goodness of fit plots for ABO blood group distribution in (D) cardiovascular complications, (E) ICU admissions, (F) 30-day mortality. Clinical Outcomes in Patients Hospitalised with SARS-CoV-2 Negative Respiratory Infection are shown in Supplementary Data 6.
Figure Three
Figure Three. Logistic Regression Modelling of Cardiovascular Complications and ICU Admission
Logistic Regression Odds Ratios for Cardiovascular Complications in patients hospitalised with (A) acute lower respiratory tract disease and (B) pneumonia, and (C) ICU Admission in patients hospitalised with acute lower respiratory tract disease.
Figure Four
Figure Four. Cox Proportional Hazard Models of 30-day Mortality
Cox proportional hazard model forest plots for 30-day mortality in patients hospitalised with (A) Respiratory Infection, (B) Pneumonia and (C) NP-LRTI
Figure 5
Figure 5. Cox Proportional Hazard Models for Hospital Length of Stay
Cox proportional hazard model forest plots for hospital length of stay in patients hospitalised with (A) Respiratory Infection, (B) Pneumonia and (C) NP-LRTI
See this image and copyright information in PMC

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