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. 2021 Aug 26;31(9):2619-2627.
doi: 10.1016/j.numecd.2021.06.016. Epub 2021 Jul 6.

Low-density lipoprotein cholesterol levels are associated with poor clinical outcomes in COVID-19

Álvaro Aparisi  1 , Carolina Iglesias-Echeverría  1 , Cristina Ybarra-Falcón  1 , Iván Cusácovich  2 , Aitor Uribarri  1 , Mario García-Gómez  1 , Raquel Ladrón  1 , Raúl Fuertes  3 , Jordi Candela  1 , Javier Tobar  1 , Williams Hinojosa  1 , Carlos Dueñas  2 , Roberto González  2 , Leonor Nogales  4 , Dolores Calvo  5 , Manuel Carrasco-Moraleja  1 , J Alberto San Román  6 , Ignacio J Amat-Santos  6 , David Andaluz-Ojeda  7
Affiliations

Low-density lipoprotein cholesterol levels are associated with poor clinical outcomes in COVID-19

Álvaro Aparisi et al. Nutr Metab Cardiovasc Dis. .

Abstract

Background and aims: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the sole causative agent of coronavirus infectious disease-19 (COVID-19).

Methods and results: We performed a retrospective single-center study of consecutively admitted patients between March 1st and May 15th, 2020, with a definitive diagnosis of SARS-CoV-2 infection. The primary end-point was to evaluate the association of lipid markers with 30-days all-cause mortality in COVID-19. A total of 654 patients were enrolled, with an estimated 30-day mortality of 22.8% (149 patients). Non-survivors had lower total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-c) levels during the entire course of the disease. Both showed a significant inverse correlation with inflammatory markers and a positive correlation with lymphocyte count. In a multivariate analysis, LDL-c ≤ 69 mg/dl (hazard ratio [HR] 1.94; 95% confidence interval [CI] 1.14-3.31), C-reactive protein >88 mg/dl (HR 2.44; 95% CI, 1.41-4.23) and lymphopenia <1000 (HR 2.68; 95% CI, 1.91-3.78) at admission were independently associated with 30-day mortality. This association was maintained 7 days after admission. Survivors presented with complete normalization of their lipid profiles on short-term follow-up.

Conclusion: Hypolipidemia in SARS-CoV-2 infection may be secondary to an immune-inflammatory response, with complete recovery in survivors. Low LDL-c serum levels are independently associated with higher 30-day mortality in COVID-19 patients.

Keywords: COVID-19; Coronavirus; High-density lipoprotein; Inflammation; Low-density lipoprotein; SARS-CoV-2; Total cholesterol; Triglycerides.

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Conflict of interest statement

Declaration of competing interest None.

Figures

Figure 1
Figure 1
Temporal changes in lipid profile levels in COVID-19 patients according to the clinical course of the disease: A) Total cholesterol; B) LDL-c; C) HDL-c. The horizontal lines represent the median value in each group. HDL-c: High-density lipoprotein cholesterol; LDL-c: Low-density lipoprotein cholesterol; TC: Total cholesterol.
Figure 2
Figure 2
Kaplan–Meier estimates of mortality in the total COVID-19 population according to LDL-c A) at admission and B) at the 7th day of hospitalization based on their optimal cut-off point. ∗ Time scale takes place between day 0 (day of admission) to 30 ∗∗ Day 0 represents the seventh day of admission.
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