![]() To study the effect of blood type on the severity of clinical outcomes, the distribution of blood types were compared between COVID-19 individuals who were admitted to an intensive care unit (ICU) and those of the general COVID-19 patients sample. To study effect of blood group on susceptibility of a SARS-CoV-2 infection, the distribution of blood types amongst a sample of confirmed COVID-19 individuals in Bahrain were compared to the distribution of blood types amongst the general population of Bahrain. Association was analyzed by ABO blood group and blood antibody class. In this cross-sectional observational study, we investigated the association between blood group and risk of COVID-19 infection and severity of clinical outcomes. Informed consent was waived by the National COVID-19 Research and Ethical Committee for this study due to its retrospective and observational nature, the absence of any patient identifying information, and the urgent nature of the investigation. All data used in this study was collected as part of routine medical procedures. All methods and retrospective analysis of data was approved by the National COVID-19 Research and Ethics Committee, and carried out in accordance with local and international guidelines and regulations. This committee has been jointly established by the Ministry of Health and Bahrain Defense Force Medical Services research and ethical committees in response to the pandemic, to facilitate and monitor COVID-19 research in Bahrain. The protocol and manuscript for this study were reviewed and approved by the National COVID-19 Research and Ethics Committee in Bahrain (Research and Ethical Approval Code: CRT-COVID2020-084). Hence, our objective is to identify whether the risk of COVID-19 infection and severity of clinical outcomes are associated with ABO blood groups and antibodies. This recent contradiction to the literature has added ambiguity to the field. reports contradicting observations, where higher risk of infection was observed for individuals of blood group B instead of A 13. Further analysis of this data was conducted by antibodies, classifying blood groups as anti-A (blood groups B and O) and anti-B (blood groups A and O), and suggested that anti-A antibodies are less associated with COVID-19 12. These findings have been replicated in several other reports 7, 8, 9, 10, 11. for SARS-Cov-2, with blood group A showing a higher risk of COVID-19 infection and mortality, and blood group O showing a decreased risk 6. This observation was first reported by Zhao et al. This is not unlikely, as many studies previously suggested associations between blood group and other diseases and infections, including SARS-CoV-1 3, 4, 5. Several studies have emerged showing an association between ABO blood types and the risk of COVID-19 infection. ![]() There is currently no known biological biomarker that can predict the risk of being infected. Critically ill cases are most likely to raise the epidemiological curve for COVID-19, and overburden the health care system 2, and hence identifying individuals most at risk is critical to managing the pandemic. The rapid spread of the disease has inflicted immense strains on healthcare and testing resource. ![]() Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus causing the current COVID-19 pandemic, has led to over 100 million cases and 2 million deaths worldwide 1. The current study, along with the variation in blood group association results, indicates that blood group may not be an ideal biomarker to predict risk of COVID-19 infection. No association between antibodies and both risk of infection or susceptibility to severe infection was found. We extended the analysis to study the association by antibodies anti-a (blood groups B and O) and anti-b (blood groups A and O). No association was observed between blood group and the risk of a severe ICU-requiring infection. We found a higher risk associated with blood group B, and a lower risk with blood group AB. In this study, we used retrospective observational data in Bahrain to investigate the association between ABO blood group and risk of infection, as well as susceptibility to severe ICU-requiring infection. Several studies emerged suggesting an association between ABO blood group and the risk of COVID-19 infection. ![]() There is currently no known biological biomarker that predicts the risk of infection. Since its emergence in December 2019, research has been focused on treating the infected, identifying those at risk and preventing spread. The COVID-19 pandemic has affected more than 100 million cases and caused immense burdens on governments and healthcare systems worldwide.
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