Infectious Disease

High blood viscosity may predict mortality in COVID-19 hospitalization

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The authors report no relevant financial disclosures.

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Blood viscosity calculated using the Walburn-Schneck model may serve as an effective prognostic tool in hospitalized patients with SARS-CoV-2 infection, according to data published in the Journal of the American College of Cardiology.

Researchers reported that high estimated blood viscosity in the arteries was associated with an approximately 60% increased risk for mortality among patients hospitalized with COVID-19.

“Estimated blood viscosity can be derived from routine laboratory tests that include the hematocrit and globulins — total protein minus albumin,” Robert S Rosenson, MD, director of metabolism and lipids for the Mount Sinai Health System and professor of medicine in cardiology at the Icahn School of Medicine at Mount Sinai, told Healio. “Using the formula for estimated high-shear blood viscosity and low-shear viscosity, we evaluated the risk of mortality in patients hospitalized with COVID-19 infection within the Mount Sinai Health System hospitals. After extensive adjustment for potential confounders, we report that estimated blood viscosity at high shear and low shear were predictive of mortality. Importantly, estimated blood viscosity was more important than D-dimer and other biomarkers used to identify patients at high risk for cardiovascular events and mortality. These associations remained significant after adjustment for the systemic inflammatory proteins.”

Calculating blood viscosity

Robert S Rosenson

Rosenson and colleagues utilized the Walburn-Schneck model to calculate estimated blood viscosity in 5,621 patients hospitalized with COVID-19 at the Mount Sinai Health System from Feb. 2, 2020, to Nov. 27, 2021.

Ranges of estimated high-shear viscosity, as seen in the arteries, and low-shear viscosity, as seen in smaller blood vessels, were separated into quartiles, and researchers compared the highest quartile of blood viscosity with the lowest for the outcome of mortality.

It was noted that participants in the highest quartile of high-shear blood viscosity were more likely to be male, to be Black or Hispanic, have a history of diabetes and require oxygen support at the time of presentation with a positive SARS-CoV-2 infection.

Blood viscosity and mortality in COVID-19

Researchers reported that every 1 cP increase in estimated high-shear blood viscosity was associated with a 36% increase in mortality risk and every 1 cP increase in estimated low-shear blood viscosity was linked with a 7% rise in mortality risk (P for both < .001).

Compared with patients in the lowest quartile of estimated high-shear blood viscosity, the highest quartile was associated with 60% greater mortality risk in the fully adjusted model (adjusted HR = 1.6; 95% CI, 1.09-2.35; P = .2) .

Patients in the highest quartile of low-shear blood viscosity had a more than 30% greater mortality risk compared with those in the lowest quartile (aHR = 1.32, 95% CI, 1.06-1.64; P = .045).

Moreover, the association between blood viscosity and mortality in COVID-19 hospitalization remained consistent across several subgroups, including patients with no comorbidities (aHR = 1.69; 95% CI, 1.28-2.22).

After adjustment for other inflammatory markers, addition of white blood cell count level (P = .158) and D-dimer level (P = .07) did not alter the predictive value of blood viscosity for in-hospital death.

“Programming the estimate blood viscosity into the laboratory system and electronic medical record will generate these data that can be used by the clinician to identify these high-risk patients,” Rosenson tole Healio. “This prospective study was not a clinical trial, but we are in the process of investigating therapies that lower blood viscosity and cardiovascular events and venous thromboembolic events. There is an NIH-funded trial of plasma exchange ongoing.”

For more information:

Robert S Rosenson, MDcan be reached at robert.rosenson@mssm.edu.

References:

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