Pre-exposure immunohematologic features of heart failure associate with COVID-19 mortality

Chronic heart failure, like diabetes, is a pro-inflammatory cardiometabolic condition, but its association with immunodeficiency is less well established. We conducted a retrospective cohort study of US Veterans infected during the first wave of COVID-19 (n = 92,533) to identify relationships between comorbidities, pre-infection immunohematologic (IH) features (based on complete blood cell count parameters), and 60-day mortality. A biomarker sub-analysis of anti-SARS CoV2 antibodies and cytokine levels was also performed (n = 44). Heart failure was independently associated with higher COVID-19 mortality and with the specific IH alterations (especially relative anemia, anisocytosis, and lymphopenia) which themselves predicted non-survival or protracted inflammation. Over half the risk conferred by heart failure was mediated by its anticipatory IH features whereas diabetes risk was unrelated to its associated IH profile. These findings indicate that heart failure is associated with a COVID-19 immunodeficiency distinct from that of diabetes which correlates with antecedent erythrocyte and lymphocyte dyshomeostasis.