The ABO Histo-Blood Group and AKI in Critically Ill Patients with Trauma or Sepsis

John P Reilly, Brian J Anderson, Nilam S Mangalmurti, Tam D Nguyen, Daniel N Holena, Qufei Wu, Ethan T Nguyen, Muredach P Reilly, Paul N Lanken, Jason D Christie, Nuala J Meyer, Michael G S Shashaty, John P Reilly, Brian J Anderson, Nilam S Mangalmurti, Tam D Nguyen, Daniel N Holena, Qufei Wu, Ethan T Nguyen, Muredach P Reilly, Paul N Lanken, Jason D Christie, Nuala J Meyer, Michael G S Shashaty

Abstract

Background and objective: ABO blood types are determined by antigen modifications on glycoproteins and glycolipids and associated with altered plasma levels of inflammatory and endothelial injury markers implicated in AKI pathogenesis. We sought to determine the association of ABO blood types with AKI risk in critically ill patients with trauma or sepsis.

Design, setting, participants, & measurements: We conducted two prospective cohort studies at an urban, academic, level I trauma center and tertiary referral center; 497 patients with trauma admitted to the surgical intensive care unit between 2005 and 2010 with an injury severity score >15 and 759 patients with severe sepsis admitted to the medical intensive care unit between 2008 and 2013 were followed for 6 days for the development of incident AKI. AKI was defined by Acute Kidney Injury Network creatinine and dialysis criteria.

Results: Of 497 patients with trauma, 134 developed AKI (27%). In multivariable analysis, blood type A was associated with higher AKI risk relative to type O among patients of European descent (n=229; adjusted risk, 0.28 versus 0.14; risk difference, 0.14; 95% confidence interval, 0.03 to 0.24; P=0.02). Of 759 patients with sepsis, AKI developed in 326 (43%). Blood type A again conferred higher AKI risk relative to type O among patients of European descent (n=437; adjusted risk, 0.53 versus 0.40; risk difference, 0.14; 95% confidence interval, 0.04 to 0.23; P=0.01). Findings were similar when analysis was restricted to those patients who did not develop acute respiratory distress syndrome or were not transfused. We did not detect a significant association between blood type and AKI risk among individuals of African descent in either cohort.

Conclusions: Blood type A is independently associated with AKI risk in critically ill patients with trauma or severe sepsis of European descent, suggesting a role for ABO glycans in AKI susceptibility.

Keywords: ABO histoblood group system; AKI; critical illness; sepsis; trauma.

Copyright © 2015 by the American Society of Nephrology.

Figures

Figure 1.
Figure 1.
Screening and enrollment. (A) Trauma cohort. (B) Sepsis cohort. aSome patients met more than one exclusion criterion. BMI, body mass index; BSA, body surface area; CHF, congestive heart failure; ICU, intensive care unit; ISS, injury severity score; LTACH, long–term acute care hospital; MI, myocardial infarction.
Figure 2.
Figure 2.
Adjusted risk of AKI by ABO blood type among patients of European descent. (A) Patients with trauma. (B) Patients with severe sepsis. Points represent the adjusted AKI risk for each ABO blood type. Vertical error bars represent 95% confidence intervals. P values are for the comparison of blood type A with blood type O in adjusted logistic regression models. Tables 3 and 5 list the covariates included in the final multivariable models.

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