Association of Blood Viscosity With Mortality Among Patients Hospitalized With COVID-19,Journal of the American College of Cardiology

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Association of Blood Viscosity With Mortality Among Patients Hospitalized With COVID-19
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2022-07-18 , DOI: 10.1016/j.jacc.2022.04.060
Daein Choi ₁ , Ori Waksman ₂ , Aleesha Shaik ₂ , Phyu Mar ₂ , Qinzhong Chen ₂ , Daniel J Cho ₃ , HyoungSup Kim ₃ , Robin L Smith ₄ , Sascha N Goonewardena ₅ , Robert S Rosenson ₂

Affiliation

Background

Coronavirus disease-2019 (COVID-19) is characterized by a dysfunctional immune response and abnormal blood rheology that contribute to endothelial dysfunction and thrombotic complications. Whole blood viscosity (WBV) is a clinically validated measure of blood rheology and an established predictor of cardiovascular risk. We hypothesize that increased WBV is associated with mortality among patients hospitalized with COVID-19.

Objectives

This study sought to determine the association between estimated BV (eBV) and mortality among hospitalized COVID-19 patients.

Methods

The study population included 5,621 hospitalized COVID-19 patients at the Mount Sinai Health System from February 27, 2020, to November 27, 2021. eBV was calculated using the Walburn-Schneck model. Multivariate Cox proportional hazards models were used to evaluate the association between eBV and mortality. Considered covariates included age, sex, race, cardiovascular and metabolic comorbidities, in-house pharmacotherapy, and baseline inflammatory biomarkers.

Results

Estimated high-shear BV (eHSBV) and estimated low-shear BV were associated with increased in-hospital mortality. One-centipoise increases in eHSBV and estimated low-shear BV were associated with a 36.0% and 7.0% increase in death, respectively (P < 0.001). Compared with participants in the lowest quartile of eHSBV, those in the highest quartile of eHSBV had higher mortality (adjusted HR: 1.53; 95% CI: 1.27-1.84). The association was consistent among multiple subgroups, notably among patients without any comorbidities (adjusted HR: 1.69; 95% CI: 1.28-2.22).

Conclusions

Among hospitalized COVID-19 patients, increased eBV is significantly associated with higher mortality. This suggests that eBV can prognosticate patient outcomes in earlier stages of COVID-19, and that future therapeutics aimed at reducing WBV should be evaluated.

中文翻译：

COVID-19住院患者血液粘度与死亡率的关系

背景

冠状病毒病 2019 (COVID-19) 的特点是免疫反应功能失调和血液流变学异常，导致内皮功能障碍和血栓并发症。全血粘度 (WBV) 是经过临床验证的血液流变学指标，也是心血管风险的既定预测指标。我们假设 WBV 增加与 COVID-19 住院患者的死亡率相关。

目标

本研究旨在确定估计的 BV (eBV) 与住院 COVID-19 患者死亡率之间的关联。

方法

研究人群包括从 2020 年 2 月 27 日到 2021 年 11 月 27 日在西奈山卫生系统住院的 5,621 名 COVID-19 患者。使用 Walburn-Schneck 模型计算 eBV。多变量 Cox 比例风险模型用于评估 eBV 与死亡率之间的关联。考虑的协变量包括年龄、性别、种族、心血管和代谢合并症、内部药物治疗和基线炎症生物标志物。

结果

估计的高剪切 BV (eHSBV) 和估计的低剪切 BV 与住院死亡率增加有关。eHSBV 和估计的低剪切 BV 增加 1 厘泊分别与死亡增加 36.0% 和 7.0% 相关（P < 0.001）。与 eHSBV 最低四分位数的参与者相比，eHSBV 最高四分位数的参与者死亡率更高（调整后的 HR：1.53；95% CI：1.27-1.84）。这种关联在多个亚组中是一致的，特别是在没有任何合并症的患者中（调整后的 HR：1.69；95% CI：1.28-2.22）。