ABO Blood Group and Biomarker-Based Risk in Acute Pulmonary Embolism: A Retrospective Cohort Study

Background. Non-O ABO blood groups are known to confer an increased risk of venous thromboembolism, primarily through higher circulating levels of von Willebrand factor and factor VIII. However, it remains unclear whether ABO type affects biochemical profiles at the time of presentation or alters the prognostic value of commonly used biomarkers in acute pulmonary embolism (PE). This study examined the relationship between ABO blood group, baseline biomarkers, and short-term clinical outcomes in patients with confirmed acute PE. Methods. We performed a retrospective cohort study of adults admitted with computed tomography pulmonary angiography-verified PE at a single tertiary center. Associations between biomarkers and clinical outcomes were assessed using logistic regression adjusted for age, sex, active cancer, chronic kidney disease, obesity, and ABO group. Interaction terms tested whether ABO type modified biomarker-outcome relationships. Results. Among 317 included patients (median age 69 years), in-hospital mortality was 11.0%; 29.6% experienced severe PE, 48.3% developed infection, and 11.7% developed sepsis. Baseline biomarker distributions were similar across ABO groups, and multivariable models showed no independent association between non-O type and biomarker levels. NT-proBNP, CRP, and procalcitonin predicted in-hospital mortality, while NT-proBNP, procalcitonin, and CK-MB predicted severe PE. CRP, procalcitonin, D-dimer, creatinine, and leukocyte count were associated with infectious and septic complications. ABO type did not meaningfully modify biomarker-outcome relationships, aside from one exploratory interaction for infection. Sensitivity analyses confirmed the robustness of these findings. Conclusions. ABO blood group did not influence baseline biomarker profiles or the prognostic performance of key biomarkers in acute PE. Early outcomes were instead driven by indicators of right ventricular strain, inflammation, and renal dysfunction.