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Research Article | DOI: https://doi.org/10.31579/2690-1919/472
1Pharmacy Division, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Street, Manchester, M13 9PL UK.
2Aston Medical School, College of Health and Life Sciences, Aston University, Gosta Green, Birmingham, B4 7ET, UK.
3Department of Haematology, Sandwell and West Birmingham Hospitals NHS Trust, Hallam Street, West Bromwich, B71 4HJ, UK.
*Corresponding Author: Farooq A Wandroo, Hon Associate Professor, University of Birmingham, Consultant Haematologist, Midland Metropolitan University Hospital, Sandwell and West Birmingham Hospital NHS Trust, West Bromwich, Birmingham, UK, B714HJ.
Citation: Hala Shokr, Mandeep Marwah, Sukhjinder Marwah, Farooq Wandroo, (2025), SARS CoV-19 Infection and ABO Blood groups, correlation with Laboratory Blood Parameter analysis and Mortality, a Single Centre Study in UK, J Clinical Research and Reports, 18(5); DOI:10.31579/2690-1919/472
Copyright: © 2025, Farooq A Wandroo. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 07 January 2025 | Accepted: 03 February 2025 | Published: 26 February 2025
Keywords: Abo Rh Groups; Sars Cov-19; Severity Of Infection
Background and Aim
There is controversial evidence available on the role of blood grouping in determining the susceptibility to SARS-CoV-19 infection. It is postulated that blood group anti-A antibodies offer some protection against SARS-CoV-19 infection and severity of illness due to anti- A antibodies blocking the binding of SARS-CoV-19 to respiratory epithelium. Hence people with blood group O may be protected against SARS-CoV-19 compared with blood group A and AB patients who may do worse. The aim of this study was to retrospectively analyse the ABO Rh blood group data on patients with SARS CoV-19 admitted in a single NHS center in UK hospital trust and further correlate the severity of infection and mortality with the type of blood group.
Material and Methods
We analysed data on 604 confirmed patients with SARS-CoV-19, who’s blood groups were known, from a single NHS centre in UK, admitted between February 2020 and March 2021. We correlated ABO Rh blood groups with mortality and various clinical, haematological and biochemical parameters. Patients were classified into four groups according to their blood group (blood group A, 197 patients: blood group B, 117 patients; blood group AB, 34 patients and blood group O, 256 patients).
Results
The analysis showed a tendency towards higher mortality in patients with blood group-A. Certain biochemical and inflammatory markers were lower in patients with blood group AB with a tendency to less organ dysfunction and morbidity. Comparison between deceased patients in all groups revealed significantly higher white blood cells (WBCs) (p=0.0308), neutrophil count (p=0.0073) in the A and B blood groups compared to the AB and O groups. However no statistically significant differences were found between the four groups in regard to neutrophil to lymphocyte ratio (NLR), neutrophil to eosinophil ratio (NER) and the white blood cells* neutrophil to eosinophil ratio (WBCS*Neut/Eos) which are known prognostic factors for SARS-CoV-19. Blood group Rh positive patients tended to have higher CRP and platelet count irrespective of primary blood group but no significant impact on mortality.
Conclusion
The study shows a tendency towards more inflammatory reaction in patients with blood group A and B and Rh positive groups but with no difference in mortality between the blood groups. We acknowledge that the small sample size limits the ability to draw conclusions for a wider population but it adds valuable information and insight in to effects of blood groups on clinical outcomes and inflammatory response to SARS-CoV-19 infection. A larger multicentre retrospective data collection and analysis would be useful with inclusion of patients admitted in intensive care.
SARS-CoV-19 has infected over 600 million people and killed over 6 million people worldwide since the first reported case in Wuhan China in December 2019. In the UK over 24 million people have been infected and 220,000 people died due to SARS-CoV-19 infection [8]. Clinical COVID-19 presentation ranges from being asymptomatic, to mild influenza-like symptoms to multiple organ failure and death [9] Various risk factors have been proposed to be correlated with mortality which includes age, male gender, ethnicity, comorbidities such as diabetes, obesity, cancer and immunocompromised state [7,10,11,12,13].
Hospitals worldwide have collected data prospectively as patients with COVID-19 present looking for patterns in clinical findings and patient specific demographics/markers that may predict risk of a poor health outcome in a variety of patient groups. Collected during an emerging pandemic, many of these have limitations, however, additional to learning from individual outcomes, publication allows the possibility of future data pooling and meta-analysis to increase the reliability of findings. Previously reported evidence suggests there may be increased risk of viral infections like hepatitis B and HIV in patients wih blood group A [14] and lower risk of hepatitis B in patients with blood group B [15]. It is postulated that blood group anti-A antibodies offer some protection against SARS-CoV-19 infection and severity of illness due to anti- A antibodies blocking the binding of SARS-CoV-19 to respiratory epithelium. Hence people with blood group O may be protected against SARS-CoV-19 compared with blood group A and AB patients who may do worse [1,2]. Many studies have therefore also looked at ABO blood groups as a risk factor for SARS-CoV-19 infection, severity of illness and death, with interesting but confounding findings. A review of studies published until January 2021 showed nine large studies on blood groups and SARS-CoV-19 related infection and severity. A significant correlation with ABO-Rh blood grouping and risk of infection and severity of illness and mortality with SARS-CoV-19 has been observed [16,17,18,19,20]. From these analysis blood group O and Rh negative appear to be protective against COVID-19 infection and severity of illness as compared to non-O and Rh positive individuals although all these studies are not uniform. There are however several other studies that although may have found higher risk of SARS-CoV-19 infection in blood group A, the severity of association is disputed [21,22].
The mechanism by which a blood group may be protective is not well understood. Blood groups have been known to be associated with malignancy, thromboembolic disorders as well as viral, bacterial and parasitic infections [23,24,25]. Blood group antigens act as receptors for pathogens and facilitate their intracellular uptake [26]. ABO polymorphism has been shown to associated with susceptibility to SARS CoV-19 and protective effect of anti-A antibodies against SARS-CoV 19 by interfering with adhesion of SARS-CoV-19 antigen to angiotensin receptor -2 expressing respiratory epithelial cells [2,27]. Other reports suggest anti-A immunoglobulin isotype, differences in serum Von Willebrand factor levels (VWF) in different ABO blood groups and anti-A iso-haemaglutinin titres [1,28,29,30,31].
We analysed data on patients with SARS-CoV-19 infection admitted to a single NHS trust in UK with varying ethnic mix. We performed a comparative analysis of ABO groups and other clinical and laboratory variables in order to see if ABO-Rh groups had a direct bearing on risk of infection with SARS-CoV-19 and its severity in this multi-ethnic population.
2.1. Study Design and Participants
This is a retrospective cohort study that included patients with confirmed COVID-19 infection, hospitalised for acute complications between February 2020 and March 2021, at a single UK National Health Trust (NHS).
Patients were identified as COVID-19 positive by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) from throat/nose swabs on a ROCHE COBAS analyser. Nasopharyngeal or oropharyngeal samples were collected from patients for the detection of SARS-CoV-19 RNA. The Xpert® Xpress SARS-CoV-real-time RT-PCR assay was performed to achieve qualitative detection of SARS-CoV-19 RNA. Ethical approvals were obtained through the Integrated Research Approval System (289571), sponsored by the research and development committee of the Trust site (20Haem60) and was designed and conducted in accordance with the tenets of the Declaration of Helsinki.
A total number of 604 patient with CoVID-19 confirmed cases were included in this study. Patients were classified into four groups according to their blood group (blood group A, 197 patients: blood group B, 117 patients; blood group AB, 34 patients and blood group O, 256 patients). Demographic information, clinical data and laboratory tests were collected from the patients’ hospital electronic medical records (EMR). All patients received treatment strategies that were recommended by the UK National Health Service (NHS) COVID-19 management protocols [41].
2.2. General Assessments
Standard anthropometric measures of height and weight were recorded to determine body mass index (BMI = weight/height). Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured using an automatic Blood Pressure monitor (UA-767; A&D Instruments Ltd., Wokingham, UK) to determine mean arterial pressure (MAP = 2/3 DBP + 1/3 SBP). Eye opening and motor and verbal responses were assessed to all patients to objectively measure their level of consciousness using Glasgow Coma Score (GCS).[42]
2.3. Laboratory Procedures
Blood and plasma samples drawn from the antecubital fossa vein were assessed immediately for fasting glucose (GLUC), triglycerides (TG), total cholesterol (T-CHOL), high-density lipoprotein cholesterol (HDL-C), blood urea, bilirubin, alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate aminotransferase (AST), creatinine (CRE) using the Reflotron Analyzer). Low-density lipoprotein cholesterol (LDL-C) values were calculated using the Friedewald equation. Lactate dehydrogenase (LDH), C-reactive protein (CRP) and ferritin (FER) were examined using a clinical chemistry analyzer). Serum albumin levels (Alb) were measured using the ARCHI. TECT c Systemsinstrument using the 7D53 B albumin assay kit
A Sysmex XN automated haematology analyser was used for complete blood count analysis including white blood cells (WBCs), haemoglobin (Hb), mean corpuscular volume (MCV), platelets (PLT), neutrophils (Neut), lymphocytes (Lymph), monocytes (Mono), eosinophils (Eos) and basophils (Baso) count. LAU ratio was calculated by dividing the LDH concentration by the albumin/urea concentration.
INR and D-Dimer values were measured using ACL TOP coagulation analyzer. For D-Dimer a Latex Reagent was used, which is a suspension of polystyrene latex particles of uniform size coated with the F(ab’)2 fragment of a monoclonal antibody highly specific for the D-Dimer domain included in fibrin soluble derivatives to allow a more specific D-Dimer detection avoiding the interference of endogenous factors like the Rheumatoid Factor. When plasma, which contains D-Dimer, is mixed with the Latex Reagent and the Reaction Buffer included in the D-Dimer HS 500 kit, the coated latex particles agglutinate. The degree of agglutination is directly proportional to the concentration of D-Dimer in the sample and is determined by measuring the decrease of the transmitted light caused by the aggregates (turbidimetric immunoassay).
For prothrombin time (PT) the principle of Coagulometric (turbidimetric) clot detection is used in the system to measure and record the amount of time required for a plasma specimen to clot. This technique assesses coagulation endpoint by measuring change in optical density.
INR was calculated using the following equation, where ISI is the international sensitivity index. All laboratory tests were conducted within 3 days of COVID-19 diagnosis.
INR= (PT test/PT normal) ISI [44]
2.4. Sample Size and Statistical Analysis
As the study design was multifactorial in nature, it was calculated that a sample size of n = 604 is sufficient to provide 80% power at an alpha level of 0.05. All analyses were performed using SPSS® statistical software (version 25, IBM Corp., Armonk, NY, USA). Distributions of continuous variables were determined by the Shapiro–Wilk test. In cases where the normality of the data could not be confirmed, appropriate data transformations were made, or non-parametric statistical alternatives were used. Univariate associations were determined using Pearson’s (normally distributed data) or Spearman’s method (non-normally distributed data). Differences between groups were subsequently assessed using independent-samples t-test or ANCOVA, as appropriate. p < 0>
There were statistically significant differences between the four study groups with regard to mean age (p = 0.016) where patients with blood groups B & AB were younger than patients with blood groups A &O. No statistically significant differences were found between the four groups with regard to SBP (systolic blood pressure), DBP (diastolic blood pressure), HR (heart rate) and Glasgow Coma Scale (GCS) (Table 1).
GP (A) (197) | GP (B) (117) | GP (AB) (34) | GP (O) (256) | P-value | Post-hoc | |
| Age | 67.05 (19.14) | 61.51 (20.26) | 60.68 (19.79) | 67.33 (18.51) | 0.016 | B & AB< A> |
| RR | 19.67 (5.62) | 20.54 (6.03) | 8.51 (2.98) | 19.38 (4.97) | 0.170 | - |
| DBP | 70.55 (16.73) | 70.87 (18.07) | 74.24 (15.13) | 71.35 (15.03) | 0.711 | - |
| HR | 80.12 (20.15) | 81.52 (21.60) | 81.27 (16.67) | 81.54 (21.03) | 0.900 | - |
| GCS | 10.06 (6.62) | 9.5 (6.85) | 9.30 (7.16) | 10.43 (6.51) | 0.58 | - |
Table 1: Demographic and clinical observations findings of patients on admission
Abbreviations: RR; respiratory rate, DBP; diastolic blood pressure, HR; heart rate; GCS; Glasgow Coma Scale
Similarly, no statistically significant differences were found between the four groups in regard COVID-19 prognostic haematological ratios including the neutrophil to lymphocyte ratio (NLR), neutrophil to eosinophil ratio (NER) and the white blood cells* neutrophil to eosinophil ratio (WBCS*Neut/Eos) (Table 2).
GP (A) (197) | GP (B) (117) | GP (AB) (34) | GP (O) (256) | P-value | |
| NLR | 8.7(10.26) | 6.91(7.08) | 6.71(10.05) | 7.72(8.59) | 0.254 |
| NER | 202.98(1562.21) | 59.43(68.95) | 62.43(64.27) | 52.39(90.28) | 0.572 |
| WBCS*Neut/Eos | 5346.94 (1783) | 3150.03(5662.29) | 2728.62(5961.84) | 2479.74 (5441.70) | 0.34 |
Table 2: Haematological Ratios Among Study Population
Abbreviations: NLR; neutrophil to lymphocyte ratio, NER; neutrophil to eosinophil ratio, WBCS*Neut/Eos; white blood cells* neutrophil to eosinophil ratio
Analysis of haematological findings of the study population showed statistically significant differences between the study groups with regard Glycated haemoglobin (HB-A1C) where group AB patients had higher HB-A1C levels compared to group A, B and O (p=0.002, 0.012, 0.032 respectively). On the other hand, mean corpuscular volume (MCV) was statistically lower in the AB group compared to group A, B and O (p=0.01, 0.004 and 0.023 respectively). No other statistically significant differences were identified between the 4 four groups regarding the rest of the assessed haematological parameters (p>0.05 in all) (Table 3).
GP (A) (197) | GP (B) (117) | GP (AB) (34) | GP (O) (256) | P-value | Post-hoc | |
| HB-A1C | 47.61 (12.02) | 49.86 (12.71) | 63.11 (16.83) | 52.95 (17.85) | 0.004* | AB>A, B &O |
| T-CHOL | 4.38 (0.97) | 4.10 (1.00) | 4.43 (1.33) | 4.44 (1.062) | 0.635 | - |
| WBCs | 10.15 (19.66) | 8.33 (4.16) | 7.78 (3.94) | 7.98 (4.46) | 0.265 | - |
| HB | 122.58 (24.52) | 120.43 (26.43) | 113.06 (26.25) | 123.22 (21.81) | 0.154 | - |
| MCV | 87.86 (8.68) | 86.09 (10.1) | 84.06 (12.82) | 88.12 (8.60) | 0.047* | AB< A> |
| PLT | 240.52 (114.16) | 244.24 (112.4) | 230.89 (105.33) | 244.80 (107.68) | 0.916 | - |
| Neut | 6.90 (8.20) | 6.37 (3.73) | 5.62 (3.63) | 6.11 (3.98) | 0.452 | - |
| Lymph | 1.95 (1.30) | 1.31 (0.85) | 1.58 (1.72) | 1.18 (1.30) | 0.664 | - |
| Mono | 0.89 (0.40) | 0.55 (0.41) | 0.49 (0.37) | 0.58 (0.35) | 0.498 | - |
| Eos | 0.057 (0.17) | 0.054 (0.14) | 0.044 (0.68) | 0.0713 (0.33) | 0.881 | - |
| Baso | 0.025 (0.028) | 0.028 (0.42) | 0.024 (0.24) | 0.025 (0.029) | 0.810 | - |
| INR | 1.26 (0.80) | 1.24 (0.62) | 1.13 (0.25) | 1.18 (0.42) | 0.542 | - |
| D-dimer | 4.84 (0.18) | 1.12 (0.12) | 1.81 (2.65) | 5.20 (1.41) | 0.705 | - |
| Mg | 0.85 (0.14) | 0.84 (0.14) | 0.79 (0.098) | 0.83 (0.13) | 0.316 | - |
| Urea | 9.05 (7.15) | 7.52 (5.16) | 7.90 (6.30) | 8.40 (6.01) | 0.210 | - |
| Na | 136.63 (4.95) | 135.81 (5.32) | 134.89 (4.70) | 135.97 (5.01) | 0.222 | - |
| K | 4.09 (0.55) | 4.08 (0.54) | 4.05 (0.51) | 4.1 (0.63) | 0.955 | - |
| Albumin | 34.76 (5.24) | 35.40 (6.0) | 37.0 (4.03) | 35.26 (4.47) | 0.161 | - |
| Bilirubin | 11.69 (9.3) | 12.4 (15.1) | 9.28 (5.17) | 10.5 (7.36) | 0.236 | - |
| ALP | 101.11 (74.11) | 118.3 (135.8) | 95.71 (42.39) | 108.5 (68.35) | 0.358 | - |
| ALT | 39.82 (78.24) | 43.45 (46.75) | 29.59 (25.20) | 35.93 (37.11) | 0.547 | - |
| CRE | 111.56 (77.04) | 105.05 (56.72) | 108.37 (66.41) | 113.90 (95.24) | 0.808 | - |
| CRP | 106.64 (92.38) | 100.52 (84.34) | 81.25 (99.53) | 97.93 (91.44) | 0.558 | - |
| FER | 908.10 (1357.2) | 897.0 (1716.2) | 592.41 (767.89) | 983.18 (1428.9) | 0.832 | - |
| LDH | 523.89 (410.47) | 528.30 (351.01) | 370.44 (138.55) | 417.17 (258.33) | 0.089 | - |
| cTnI | 314.03 (148.8) | 62.92 (197.23) | 16.69 (15.79) | 139.96 (635.24) | 0.349 | - |
| 25OHD | 45.47 (30.8) | 46.22 (27.97) | 37.14 (23.58) | 46.69 (30.32) | 0.826 | - |
Table 3: Haematological Findings and Organ Function tests of the whole Study Population
Abbreviations: HB-A1c, haemoglobin A1C; T-CHOL, total cholesterol; WBCs, white blood cells; Hb, haemoglobin; MCV, mean corpuscular volume; PLT, platelets; Neut, neutrophils; Lymph, lymphocytes; Mono; monocytes; Eos, eosinophils; Baso, basophils; INR; INR, international normalized ratio; Mg; magnesium, Na; sodium, K; postassium, ALP, alkaline phosphatase; ALT, Alanine transaminase; CRE, creatinine; CRP, C-reactive protein; FER, ferritin, LDH, lactate dehydrogenase; cTnI, cardiac troponin-I; 25OHD, 25-hydroxycholecalciferol.
* Significant p-values are indicated where p < 0>
No statistically significant difference was found regarding the number of patients died in each group (A= 30%, B=25%, AB=22% and O= 33%) (Figure 1).
Comparison between deceased patients in all groups revealed significantly higher white blood cells (WBCs) (p=0.0308), neutrophil count (p=0.0073) in the A and B blood groups compared to the AB and O groups. Monocytes (p= 0.0332), D-dimer (p=0.00903), urea (p=0.0208), bilirubin (p=0.0113) and C-reactive protein (p= 0.0178) concentrations were lower in AB group compared to A, B and O groups, while 25-hydroxycholecalciferol was higher in A group compared to the B, AB, and O groups (Table 4).
Table 4: Haematological Findings and Organ Function tests of the Deceased Patients in Each Group
Abbreviations: HB-A1c, haemoglobin A1C; T-CHOL, total cholesterol; WBCs, white blood cells; Hb, haemoglobin; MCV, mean corpuscular volume; PLT, platelets; Neut, neutrophils; Lymph, lymphocytes; Mono; monocytes; Eos, eosinophils; Baso, basophils; INR; INR, international normalized ratio; Mg; magnesium, Na; sodium, K; postassium, ALP, alkaline phosphatase; ALT, Alanine transaminase; CRE, creatinine; CRP, C-reactive protein; FER, ferritin, LDH, lactate dehydrogenase; cTnI, cardiac troponin-I; 25OHD, 25-hydroxycholecalciferol.
* Significant p-values are indicated where p < 0>
Similar to whole population analysis no statistically significant differences were found between the four groups in regard COVID-19 prognostic haematological ratios including NLR, NER and the WBCS*Neut/Eos ratio (p>0.05 in all) (Table 5).
Comparison of the study population using Rh blood group system showed lower HB-A1C and 25-OH concentrations in the A+ compared to the A-
group (p=0.028 and 0.045 respectively). Similarly, lower HB-A1C concentrations were found in the O+ compared to the O- group (p=0.001). On the other hand, platelets count was higher in the B+ compared to the B- group (p=0.001), while CRP was higher in the in the O+ compared to the O- group (p= 0.006)
GP (A) (71) | GP (B) (30) | GP (AB) (8) | GP (O) (85) | P-value | |
| NLR | 10.70 (10.56) | 10.44 (10.35) | 4.35 (2.45) | 8.99 (10.03) | 0.150 |
| WBCs*Neut/Eso | 12128.86 (30314.55) | 5975.08 (10262.76) | 240.77 (282.8) | 2368.85 (3422.68) | 0.132 |
| NER | 463.68 (651.13) | 388.51 (403.05) | 43.87 (13.96) | 355.92 (455.31) | 0.158 |
Table 5: Haematological Ratios Among Deceased Patients in each Study Population
Abbreviations: NLR; neutrophil to lymphocyte ratio, NER; neutrophil to eosinophil ratio, WBCS*Neut/Eos; white blood cells* neutrophil to eosinophil ratio.
This is a retrospective review of patients with SARS-CoV-19 infection who were admitted at a single NHS trust in UK who’s blood groups were known. The analysis on 604 patients showed that majority were with blood group O(256), followed by group A(197), group B (117) and group AB (34). The three groups had similar mean age, with blood groups O and A being older. There were no significant differences in clinical observations such as blood pressure, heart rate or Glasgow Coma Scale (GCS) suggesting no differences in the severity of illness among four groups. However, in our study clinical and laboratory responses in different ABO blood groups are interesting to note. We note group AB patients may have a lower risk of organ dysfunction or respiratory failure due to COVID-19. Although we found no significant statistical difference in mortality between different ABO groups, in fact blood group O had the highest mortality amongst all four groups but certain haematological indices and biochemical markers of inflammation were favourable in patients with blood group AB with a tendency to lower mortality. In this study we did note that neutrophil/Lymphocyte (N/L) ratio which is a known adverse factor for severity of SARS-CoV-19 infection was higher in patients with blood group A compared with other groups. This suggests more severe inflammatory response inpatients with blood group A[7]. Of interest this study also showed higher WBC/neut/eosinophil ratio in patients with blood group A. Our study is consistent with four other studies that have shown no significant correlation of ABO blood groups with mortality in patients with SARS-CoV-19. Battacharia et al in their pooled meta-analysis of eleven studies including 233006 patients did not show any correlation of ABO blood groups with adverse mortality [3]. The meta-analysis did not however include all studies published on severely ill patients in intensive care, hence interpretation of this analysis should be taken with caution. Unfortunately we don’t have data on gender distribution in this data set as we know males often do poorly with SARS-CoV-19 infection. Our study also lacks data on patients admitted to intensive care which represents seriously ill patients. Adua et al did a detailed analysis of nine published studies on ABO blood grouping in patients with SARS-CoV-19 published till January 2021. These studies cover thousands of patients across different continents and ethnic groups. Five of these studies showed correlation of some blood groups with susceptibility to SARS-CoV 19 infection, but the type of blood group susceptible to infection varied in these studies. However only four of nine studies showed correlation with severity of infection and mortality [16]. Analysing these studies in more detail, Ray et all published one of the largest study from Canada on blood type in patients with COVID-19. They found blood group O and Rh negative individuals were less susceptible to COVID-19 and had less severe secondary outcomes [17]. Zhao et al also found similar findings in a Chinese study on COVI-19 and found that people with blood group O were infected less often and had lower mortality as compared to patients with blood group A. They also found blood group B and AB were not at increased risk of infection [18]. Zietz et al from a study in New York also found patients with blood group A more susceptible to COVID-19 infection but contrary to other studies mortality and rate of intubation was less in patients with blood group-A as compared to blood group B and AB [19], similar to our study. Another study by Hoiland et al also found blood group A and AB had a prolonged stay in intensive care and were more likely to require intubation [20].
Similarly a meta-analysis of Spanish and Italian cohort when adjusted for age and gender did show worst outcome with increased incidence of respiratory failure in patients with blood group A and AB [34]. Recent further meta-analyses of 30 studies on SARS CoV-19 infection and ABO blood groups, 14 studies showed increased susceptibility in patients with blood group A as compared with 15 studies which showed reduced risk of infection in patients with blood group O but without any effect on mortality [43].
We did not have enough data in this study on Rh groups, although there was a tendency for higher inflammatory markers and platelet count in patients who were Rh blood group positive irrespective of primary blood ABO blood group. Blood group Rh have been shown to correlate with risk of SARS-CoV-19 infection and severity of illness in at least five studies [19,32,33)]. Two further studies showed that Rh negative groups are associated with less risk of infection, severity of illness and mortality whereas studies by Adua and Leaf et all only showed reduced risk of infection without an impact on mortality [4,16,17,19,].
A large meta-analysis of two case control studies in Spain and Italy on genetic susceptibility to SARS-CoV-19 confirmed replicating gene cluster at locus 3p21.31comprising of six genes (SLC6A20,LZTFL1,CCR9,FYCO1,CXCR6 and XCR1) which may make us susceptible to SARS-Cov-19 infection. They demonstrated that the frequency of the risk allele of the lead variant at 3p21.31 (rs11385942 gene GA or G) was higher among patients who received mechanical ventilation than among those who received oxygen supplementation only. This risk allele is associated with reduced expression of CXCR6 but increased expression of SLC6A20 and LZTLF1in lung epithelium. The same study also showed replicating gene cluster at locus 9q34.2 (rs657152 A or C) that showed higher risk in blood Group A with respiratory failure than other blood groups as well as protective effect in blood group O [34]. One of these genes SLC6A20, encodes the sodium–imino acid (proline) transporter 1 (SIT1) and functionally interacts with ACE-2 receptor [38,39]. Other genes at this locus encode CC motif chemokine receptor 9 (CCR9) and the C-X-C motif chemokine receptor 6 (CXCR6) which is important for regulation of specific location of lung-resident memory CD8 T cells during immune response to various pathogens like influenza viruses [40]. This may also explain the severity of disease in patients with blood group A patients.
Ethnic origin, blood group and risk of infection with SARS-CoV -19
There is paucity of data on ethnic correlation with blood groups. Leaf et al also looked at ethnicity and blood groups and found correlation with blood group A in Caucasians only in whom blood group A was overrepresented, whether this could be explained by genetic polymorphism remains unknown. Our study was done on multi-ethnic population however we did not have full data on ethnicity [4].
To conclude since the spread of SARS-CoV-19 infection, several studies have looked at susceptibility of patients with different ABO and Rh blood groups. Majority of these studies have shown some association with ABO Rh blood groups and SARS-CoV-19 infection but only few have shown an impact on severity of illness and mortality. Many of these studies are limited in sample size, lack data on critically ill patients and ethnicity. These studies have all been retrospective and hence likely affected by selection bias. It is difficult to come to a firm conclusion from these studies including ours as also majority of the other COVID -19 studies also lack data on blood grouping. But it does seem that blood group A and Rh positive patients may be more susceptible to the impact of SARS-Cov-19 thus these groups should be observed more closely and ensure appropriate focused care to limit further events.
This study has limitations inherent to its retrospective design. First, the reliance on previously collected data may introduce selection bias, as the dataset was not specifically designed to address our research objectives. This also limits the ability to control for potential confounding variables, as not all relevant data may have been available or consistently recorded. We did not include patients admitted to intensive care due to lack of information of blood groups. They were obviously more severely ill and could have given us more valuable information. There is also an overall selection bias because not all COVID-19 patients admitted to hospital had blood groups done Second, the accuracy and completeness of the data depend on the quality of documentation in the original records, which may be subject to errors or omissions. This could affect the reliability of key variables and outcomes. Furthermore, the low number of patients in the AB group may limit the statistical power to detect significant differences or draw robust conclusions. Small sample sizes increase the risk of type II errors and may not adequately represent the variability within the population.
Our findings suggest a tendency toward heightened inflammatory reactions in patients with blood groups A and B, as well as Rh-positive blood types, though no significant differences in mortality were observed between the groups. We acknowledge that the small size of our study limits the ability to draw definitive conclusions for the wider population. However, it provides valuable insights into the potential effects of blood groups on clinical outcomes and inflammatory responses to SARS-CoV-19 infection. It may be that this group of patients should have more focused care. Given the current context, where the COVID-19 pandemic has subsided and infection rates are minimal, prospective data collection is unlikely. Therefore, a larger, multicenter retrospective study would be beneficial. Such an analysis, particularly one including patients admitted to intensive care units, could further validate and expand upon these findings, providing a more comprehensive understanding of the relationship between blood group types and COVID-19 outcomes
We are indebted to our colleagues from the blood sciences Laboratory, Research and Development, Information Technology, fellow clinicians, statistician and above all, all patients who's data we were able to analyze.
No conflict of interest.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
