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. 2022 Jul 26;80(4):316-328.
doi: 10.1016/j.jacc.2022.04.060.

Association of Blood Viscosity With Mortality Among Patients Hospitalized With COVID-19

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  6
Affiliations

Association of Blood Viscosity With Mortality Among Patients Hospitalized With COVID-19

Daein Choi et al. J Am Coll Cardiol. .

Abstract

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.

Keywords: COVID-19; blood viscosity; cardiovascular disease; mortality; rheology epidemiology.

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Conflict of interest statement

Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Flow Diagram of the Study Population Flow chart presenting study population. COVID-19 = coronavirus disease-2019.
Central Illustration
Central Illustration
Effects of Blood Hyperviscosity on the Vascular System in COVID-19 Adjusted HRs (aHRs) calculated by Cox proportional hazards regression after adjustments for age; sex; hospital site; race; history of hypertension, diabetes mellitus, chronic kidney disease, and coronary artery disease; in-hospital statin use; anticoagulation therapy; date of admission; measure of initial oxygen support; and initial lab data (white blood cell count, C-reactive protein, and D-dimer). COVID-19 = coronavirus disease-2019.
Figure 2
Figure 2
Kaplan-Meier Curves for Hospitalized Patients With COVID-19 According to Estimated BV Kaplan-Meier curves for in-hospital mortality among patients with coronavirus disease-2019 (COVID-19) according to (A) estimated high-shear blood viscosity (BV) and (B) estimated low-shear BV.
Figure 3
Figure 3
Restricted Cubic Spline Showing Association Between eHSBV and In-Hospital Mortality (A) Restricted cubic spline showing association between estimated high-shear blood viscosity (eHSBV) and in-hospital mortality. (B) Histogram showing the distribution of eHSBV of the study participants. Models are adjusted for age; sex; hospital site; race; history of hypertension, diabetes, chronic kidney disease, and coronary artery disease; in-hospital statin use; anticoagulation therapy; date of admission; and measure of initial oxygen support. The solid line indicates HRs and shaded areas indicate 95% CIs. Four knots were placed at the 5th, 35th, 65th, and 95th percentiles of BV.
Figure 4
Figure 4
Association of eHSBV Mortality Patients According to Subgroups (A,B) Adjusted HRs calculated by Cox proportional hazards regression after adjustments for age; sex; hospital site; race; history of hypertension, diabetes, chronic kidney disease, and coronary artery disease; in-hospital statin use; anticoagulation therapy; date of admission; and measure of initial oxygen support. COVID-19 = coronavirus disease-2019; CRP = C-reactive protein; eHSBV = estimated high-shear blood viscosity.
Figure 4
Figure 4
Association of eHSBV Mortality Patients According to Subgroups (A,B) Adjusted HRs calculated by Cox proportional hazards regression after adjustments for age; sex; hospital site; race; history of hypertension, diabetes, chronic kidney disease, and coronary artery disease; in-hospital statin use; anticoagulation therapy; date of admission; and measure of initial oxygen support. COVID-19 = coronavirus disease-2019; CRP = C-reactive protein; eHSBV = estimated high-shear blood viscosity.
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