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. 2023 Jun:52:1-8.
doi: 10.1016/j.athplu.2023.01.002. Epub 2023 Mar 6.

Low HDL-c levels at admission are associated with greater severity and worse clinical outcomes in patients with COVID-19 disease

Sandra Parra  1 , Mireia Saballs  2 , Mark DiNubile  3 , Mireia Feliu  1 , Simona Iftimie  1 , Laia Revuelta  1 , Raul Pavón  1 , Alba Àvila  1 , Susan Levinson  3 , Antoni Castro  1
Affiliations

Low HDL-c levels at admission are associated with greater severity and worse clinical outcomes in patients with COVID-19 disease

Sandra Parra et al. Atheroscler Plus. 2023 Jun.

Abstract

Background and aims: HDL particles may act to buffer host cells from excessive inflammatory mediators. The aim of this study is to investigate if the lipid profile provides a prognostic biomarker for COVID-19 outcomes.

Methods: This was a prospective study of the characteristics of 125 adult COVID-19 patients with a lipid profile performed on the day of admission analyzed with regard to clinical outcomes.

Results: Seventy-seven patients (61.2%) were men, with a mean age of 66.3 (15.6) years. 54.1% had bilateral pneumonia. The all-cause mortality rate during hospitalization was 20.8%. We found a direct association between more severe disease assessed by the WHO classification, admission to the ICU and death with more pronounced lymphopenia, higher levels of CRP, ferritin (p < 0.001), D-dímer and lactate dehydrogenase (LDH) all statistically significant. Lower leves of HDL-c and LDL-c were also associated with a worse WHO classification, ICU admission, and death,. HDL-c levels were inversely correlated with inflammatory markers CRP (r = -0.333; p < 0.001), ferritin (r = -0.354; p < 0.001), D-dímer (r = -0.214; p < 0.001), LDH (r = -0.209; p < 0.001. LDL-c levels were significantly associated with CRP (r = -0.320; p < 0.001) and LDH (r = -0.269; p < 0.001). ROC curves showed that HDL [AUC = 0.737(0.586-0.887), p = 0.005] and lymphocytes [AUC = 0.672(0.497-0.847], p < 0.043] had the best prognostic accuracy to predict death. In a multivariate analysis, HDL-c (β = -0.146(0.770-0.971), p = 0.014) and urea (β = 0.029(1.003-1.057), p = 0.027) predicted mortality.

Conclusion: Hypolipidemia including HDL levels at admission identifies patients with a higher risk of death and worse clinical manifestations who may require more intensive care.

Keywords: Biommarker; COVID-19; COVID-19, SARS-Cov2 Disesae; HDL; HDL-c, High density cholesterol; Inflammation; LDL; LDL-c, Low density cholesterol.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Differences between the WHO group [[3], [4], [5], [6], [7]] regarding the means levels of lymphocytes cell count, CRP, D-Dímer, HDL-c, LDL-c and ferritin. In this box plots there are expressed the significance between all the groups (p 0.005) and intra-groups after post-hoc analyses. a:WHO 3–4; b:WHO 3–5; c: WHO 3–6; d: WHO 3–7; e: WHO 4–5; j: WHO 4–7; g: WHO 6–7.
Fig. 2
Fig. 2
Bivariate correlations between lipid profile and inflammatory markers.
Fig. 3
Fig. 3
Fig. 2. Receiver operating characteristics (ROC) plots of variables (A) and multivariate analyses (B) with respect mortality.
See this image and copyright information in PMC

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