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Establishing Early Intervention Thresholds for High-Altitude Polycythemia: Evidence from a Cross-Sectional Study of
Zhuoga Danzeng1,2, Luobu Gesang3,4, Yangzong Suona3,4
1School of Medicine, Xizang University, Xizang, China.
Abstract:
Zhuoga Danzeng, Luobu Gesang, Yangzong Suona, Yuansheng Wang, Yangjin Baima, Bai Ci, Ju Huang, Zhuoma Ciren, Rui Zhang, Binyun Liu, and Quzong Zhaxi. Establishing Early Intervention Thresholds for High-Altitude Polycythemia: Evidence from a Cross-Sectional Study of Tibetan Residents. High Alt Med Biol. 00:00-00, 2026.
Background:
High-altitude polycythemia (HAPC), defined by elevated hemoglobin levels, is a key feature of chronic mountain sickness, yet the "intermediate zone" preceding overt HAPC remains poorly understood. This cross-sectional study aimed to define evidence-based thresholds for early intervention in high-altitude populations.
Methods:
A total of 2,819 indigenous Tibetan residents (≥18 years) living at altitudes ≥ 4,500 m were classified into three groups based on hemoglobin levels: normal (males: 130-175 g/l; females: 115-150 g/l), intermediate (males: 175-210 g/l; females: 150-190 g/l), and HAPC (males: ≥210 g/l; females: ≥190 g/l). We assessed clinical phenotypes, organ function, and metabolic parameters through questionnaires, physical exams, biochemical analyses, and echocardiography. Logistic regression identified health risks for each group.
Results:
Revealed that participants in the intermediate and HAPC groups exhibited significant abnormalities compared with the normal group: increased waist circumference (p < 0.001), elevated low-density lipoprotein cholesterol (LDL-C; p < 0.001), and higher uric acid levels (p < 0.001), with an increased risk of hyperuricemia (OR = 2.077, p < 0.001). Additionally, SpO2 was lower in the intermediate (83%) and HAPC (80%) groups, indicating worsening hypoxia (p < 0.001). Organ function abnormalities included elevated ALT levels (p < 0.001) and right ventricular wall thickness (p = 0.025).
Conclusion:
These findings suggest that individuals in the intermediate zone exhibit early signs of organ dysfunction, indicating a "pre-HAPC state." We advocate for a risk-stratified approach to early intervention in high-altitude illness.
