Impact of COVID status and blood group on complications in patients in hemorrhagic shock

Jason B Brill, Krislynn M. Mueck, Madeline E. Cotton, Brian Tang, Mariela Sandoval, Lillian S Kao, Bryan A Cotton
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Abstract

Among critically injured patients of various blood groups, we sought to compare survival and complication rates between COVID-19-positive and COVID-19-negative cohorts.SARS-CoV-2 infections have been shown to cause endothelial injury and dysfunctional coagulation. We hypothesized that, among patients with trauma in hemorrhagic shock, COVID-19-positive status would be associated with increased mortality and inpatient complications. As a secondary hypothesis, we suspected group O patients with COVID-19 would experience fewer complications than non-group O patients with COVID-19.We evaluated all trauma patients admitted 4/2020–7/2020. Patients 16 years or older were included if they presented in hemorrhagic shock and received emergency release blood products. Patients were dichotomized by COVID-19 testing and then divided by blood groups.3281 patients with trauma were evaluated, and 417 met criteria for analysis. Seven percent (29) of patients were COVID-19 positive; 388 were COVID-19 negative. COVID-19-positive patients experienced higher complication rates than the COVID-19-negative cohort, including acute kidney injury, pneumonia, sepsis, venous thromboembolism, and systemic inflammatory response syndrome. Univariate analysis by blood groups demonstrated that survival for COVID-19-positive group O patients was similar to that of COVID-19-negative patients (79 vs 78%). However, COVID-19-positive non-group O patients had a significantly lower survival (38%). Controlling for age, sex and Injury Severity Score, COVID-19-positive patients had a greater than 70% decreased odds of survival (OR 0.28, 95% CI 0.09 to 0.81; p=0.019).COVID-19 status is associated with increased major complications and 70% decreased odds of survival in this group of patients with trauma. However, among patients with COVID-19, blood group O was associated with twofold increased survival over other blood groups. This survival rate was similar to that of patients without COVID-19.
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COVID 状态和血型对失血性休克患者并发症的影响
在不同血型的重伤患者中,我们试图比较 COVID-19 阳性和 COVID-19 阴性人群的存活率和并发症发生率。我们假设,在失血性休克的外伤患者中,COVID-19 阳性与死亡率和住院并发症的增加有关。作为次要假设,我们怀疑O组COVID-19患者的并发症会少于非O组COVID-19患者。我们对 2020 年 4 月至 2020 年 7 月期间收治的所有外伤患者进行了评估。16 岁或以上的患者如果出现失血性休克并接受了紧急放血产品治疗,则被纳入评估范围。我们对 3281 名外伤患者进行了评估,其中 417 人符合分析标准。7%(29 人)的患者 COVID-19 阳性;388 人 COVID-19 阴性。COVID-19 阳性患者的并发症发生率高于 COVID-19 阴性患者,包括急性肾损伤、肺炎、败血症、静脉血栓栓塞和全身炎症反应综合征。按血型进行的单变量分析表明,COVID-19 阳性 O 组患者的存活率与 COVID-19 阴性患者相似(79% 对 78%)。然而,COVID-19 阳性的非 O 型血患者的存活率明显较低(38%)。在控制了年龄、性别和损伤严重程度评分后,COVID-19 阳性患者的存活率降低了 70% 以上(OR 0.28,95% CI 0.09 至 0.81;P=0.019)。然而,在 COVID-19 患者中,O 型血患者的存活率比其他血型患者高出两倍。这一存活率与无 COVID-19 血型的患者相似。
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