Main Article Content

Sohail khan Raja
Mohammad Ali Arshad Abbasi
Rubina Rafique Shiekh
Tashbih E Batool
Khawaja Faizan Ejaz
Muhammad Ishraf ul Islam
Amna Akbar
Maham Tariq
Sabahat Tasneem
Sarosh Khan Jadoon


COVID-19, D-dimer, NLR, ABO blood group system


Introduction: chronic obstructive pulmonary disease, asthma and tuberculosis are well known fatal disorders. Corona-virus disease of 2019 (COVID-19) caused worldwide pandemic and it affected lungs and caused deaths more than other causes combined in one year. Research has been focused on different aspects of COVID-19 since it emerged. Blood groups and inflammatory markers are being investigated. The thromboembolism marker D-dimer and other coagulation markers are intensively being studied.

Methodology: We conducted a retrospective cohort study in Azad Jammu Kashmir, Pakistan to explore the relationship between blood groups and neutrophil to lymphocyte ratio (NLR) and D-dimers in relation to disease severity and outcomes.

Results: The blood groups A and B+ve are more affected than other blood groups (58%) and NLR and D-dimer predict disease severity (p<-0.05). D-dimer is associated with blood groups, but NLR is not.

Conclusion: The present study gave good insight into role of blood groups, NLR and D-Dimer values in COVID-19 disease severity and outcomes. We recommend that further studies should be done, and more inflammatory markers must be explored as the present study represents only one area of our country.

Abstract 43 | pdf Downloads 9


1. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet (London, England). 2016 Oct;388(10053):1459–544.
2. Göker H, Aladağ Karakulak E, Demiroğlu H, Ayaz Ceylan ÇM, Büyükaşik Y, Inkaya AÇ, et al. The effects of blood group types on the risk of COVID-19 infection and its clinical outcome. Turkish J Med Sci. 2020 Jun;50(4):679–83.
3. Almadhi MA, Abdulrahman A, Alawadhi A, Rabaan AA, Atkin S, AlQahtani M. The effect of ABO blood group and antibody class on the risk of COVID-19 infection and severity of clinical outcomes. Sci Rep [Internet]. 2021;11(1):5745. Available from:
4. Dobie G, Abutalib S, Sadifi W, Jahfali M, Alghamdi B, Khormi A, et al. The correlation between severe complications and blood group types in COVID-19 patients; with possible role of T polyagglutination in promoting thrombotic tendencies. AIMS Med Sci [Internet]. 2023;10(1):1–13. Available from:
5. Latz CA, DeCarlo C, Boitano L, Png CYM, Patell R, Conrad MF, et al. Blood type and outcomes in patients with COVID-19. Ann Hematol [Internet]. 2020;99(9):2113–8. Available from:
6. Reilly JP, Meyer NJ, Shashaty MGS, Feng R, Lanken PN, Gallop R, et al. ABO blood type a is associated with increased risk of ards in whites following both major trauma and severe sepsis. Chest [Internet]. 2014 Apr 1 [cited 2023 Aug 6];145(4):753–61. Available from:
7. Cooling L. Blood Groups in Infection and Host Susceptibility. Clin Microbiol Rev. 2015 Jul;28(3):801–70.
8. Portal AO. CORONAVIRUS IN AZAD KASHMIR [Internet]. Available from:
9. Batool Z, Durrani SH, Tariq S. Association Of Abo And Rh Blood Group Types To Hepatitis B, Hepatitis C, Hiv And Syphilis Infection, A Five Year’ Experience In Healthy Blood Donors In A Tertiary Care Hospital. J Ayub Med Coll Abbottabad. 2017;29(1):90–2.
10. Lindesmith L, Moe C, Marionneau S, Ruvoen N, Jiang X, Lindblad L, et al. Human susceptibility and resistance to Norwalk virus infection. Nat Med. 2003 May;9(5):548–53.
11. Laurys Boudin, Frédéric Janvier, Olivier Bylicki, Fabien Dutasta. ABO blood groups are not associated with risk of acquiring the SARS-CoV-2 infection in young adults. Haematologica [Internet]. 2020 Jul 23;105(12 SE-Letters to the Editor):2841–3. Available from:
12. Hoiland RL, Fergusson NA, Mitra AR, Griesdale DEG, Devine D V, Stukas S, et al. The association of ABO blood group with indices of disease severity and multiorgan dysfunction in COVID-19. Blood Adv [Internet]. 2020 Oct 14;4(20):4981–9. Available from:
13. Ray JG, Schull MJ, Vermeulen MJ, Park AL. Association Between ABO and Rh Blood Groups and SARS-CoV-2 Infection or Severe COVID-19 Illness. Ann Intern Med [Internet]. 2020 Nov 24;174(3):308–15. Available from:
14. Dahlén T, Li H, Nyberg F, Edgren G. A population-based, retrospective cohort study of the association between ABO blood group and risk of COVID-19. J Intern Med [Internet]. 2023 Mar 1;293(3):398–402. Available from:
15. Jawdat D, Hajeer A, Massadeh S, Aljawini N, Abedalthagafi MS, Alaamery M. Correlation between ABO Blood Group Phenotype and the Risk of COVID-19 Infection and Severity of Disease in a Saudi Arabian Cohort. J Epidemiol Glob Health. 2022 Mar;12(1):85–91.
16. Gilmiyarova FN, Kolotyeva NA, Kuzmicheva VI, Gusyakova OA, Borodina IA, Baisheva GM, et al. [Blood group and human diseases (review of literature).]. Klin Lab Diagn. 2020;65(4):216–21.
17. Tan L, Wang Q, Zhang D, Ding J, Huang Q, Tang Y-Q, et al. Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal Transduct Target Ther [Internet]. 2020;5(1):33. Available from:
18. Ray JG, Park AL. SARS-CoV-2 vaccination, ABO blood group and risk of COVID-19: population-based cohort study. BMJ Open. 2022 Jul;12(7):e059944.
19. Zietz M, Zucker J, Tatonetti NP. Associations between blood type and COVID-19 infection, intubation, and death. Nat Commun [Internet]. 2020;11(1):5761. Available from:
20. Barnkob MB, Pottegård A, Støvring H, Haunstrup TM, Homburg K, Larsen R, et al. Reduced prevalence of SARS-CoV-2 infection in ABO blood group O. Blood Adv. 2020 Oct;4(20):4990–3.
21. Tjendra Y, Al Mana AF, Espejo AP, Akgun Y, Millan NC, Gomez-Fernandez C, et al. Predicting Disease Severity and Outcome in COVID-19 Patients: A Review of Multiple Biomarkers. Arch Pathol Lab Med [Internet]. 2020 Aug 20;144(12):1465–74. Available from:
22. Karki D, Gurung R, Nepali P, Kaphle HP, Subedi B, Adhikari S. Raised D-dimer among Admitted COVID-19 Patients in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2022 Jul;60(251):596–9.
23. Yu H-H, Qin C, Chen M, Wang W, Tian D-S. D-dimer level is associated with the severity of COVID-19. Thromb Res. 2020 Nov;195:219–25.
24. Oualim S, Abdeladim S, Ouarradi A El, Bensahi I, Hafid S, Naitlho A, et al. Elevated levels of D-dimer in patients with COVID-19: prognosis value. Pan Afr Med J. 2020;35(Suppl 2):105.
25. Shah S, Shah K, Patel SB, Patel FS, Osman M, Velagapudi P, et al. Elevated D-Dimer Levels Are Associated With Increased Risk of Mortality in Coronavirus Disease 2019: A Systematic Review and Meta-Analysis. Cardiol Rev. 2020;28(6):295–302.
26. Townsend L, Fogarty H, Dyer A, Martin-Loeches I, Bannan C, Nadarajan P, et al. Prolonged elevation of D-dimer levels in convalescent COVID-19 patients is independent of the acute phase response. J Thromb Haemost. 2021 Apr;19(4):1064–70.
27. Lehmann A, Prosch H, Zehetmayer S, Gysan MR, Bernitzky D, Vonbank K, et al. Impact of persistent D-dimer elevation following recovery from COVID-19. PLoS One. 2021;16(10):e0258351.
28. Conte G, Cei M, Evangelista I, Colombo A, Vitale J, Mazzone A, et al. The Meaning of D-Dimer value in Covid-19. Vol. 27, Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. United States; 2021. p. 10760296211017668.

Most read articles by the same author(s)