(957.4) Low Serum Erythropoietin Levels are Associated with Fatal COVID-19 Cases at 4,150 meters above sea level

Poster Board Number: E587

Christian Arias-Reyes (Centre de Recherche de l´Institute Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval), Antonio Viruez-Soto (Clínica Los Andes del Grupo Embriovid, Clínica Los Andes del Grupo Embriovid, Clínica Los Andes del Grupo Embriovid, Clínica Los Andes del Grupo Embriovid), Mónica Marlene López-Dávalos (Hospital Agramont), Gabriel Rada-Barrera (Hospital Agramont), Alfredo Merino-Luna (High Altitude Intensive Care Medicine International Group, GIMIA), Daniel Molano-Franco (High Altitude Intensive Care Medicine International Group, GIMIA), Amilcar Tinoco-Solorzano (High Altitude Intensive Care Medicine International Group, GIMIA), Natalia Zubieta-DeUrioste (High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA)), Gustavo Zubieta-Calleja (High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA)), Jorge Soliz (Université Laval, Faculté de Médecine, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Faculté de Médecine, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec)

Previous studies suggested that erythropoietin (EPO) may protect against severe COVID-19-induced injuries, ultimately preventing mortality. This hypothesis is based on the fact that, in addition to promoting the increase in red blood cells, EPO is an anti-inflammatory, anti-apoptotic and protective factor in several non-erythropoietic tissues. Furthermore, EPO promotes nitric oxide production in the hypoxic lung and stimulates ventilation by interacting with the respiratory centers of the brainstem. Given that EPO in the blood is increased at high-altitude, we evaluated the serum levels of EPO in critical patients with COVID-19 at “Hospital Agramont” in the city of El Alto (4,150 masl) in Bolivia. A total of 16 patients, 15 men, one woman, with a mean age of 55.8 ± 8.49 years, admitted to the Intensive Care Unit were studied. All patients were permanent residents of El Alto, with no travel history below 3,000 masl for at least one year. Blood samples were collected upon admission to the ICU. Serum EPO concentration was assessed using an ELISA kit, and a standard technique determined hemoglobin concentration. Only half of the observed patients survived the disease. Remarkably, fatal cases showed 2.5 times lower serum EPO than survivors (2.78 ± 0.8643 mU/ml vs 7.06 ± 2.713 mU/ml; p = 0.0096), and 1.24 times lower hemoglobin levels (13.96 ± 2.56 g/dL vs 17.41 ± 1.61 g/dL; p = 0.0159). While the number of cases evaluated in this work is low, our findings strongly warrant further investigation of EPO levels in COVID-19 patients at high and low altitudes. Our results also support the hypothesis that exogenous EPO administration could help critically ill COVID-19 patients overcome the disease.