Background: The pandemic of coronavirus disease 2019 (COVID-19) has become a global threat to public health. The lipid pathophysiology in COVID-19 is unknown.
Methods: In this retrospective longitudinal study, we monitored the serum lipids in 17 surviving and 4 non-surviving COVID-19 cases prior to their viral infections and duration the entire disease courses.
Results: In surviving cases, the low-density lipoprotein (LDL) levels decreased significantly on admission as compared with the levels before infection; the LDL levels remained constantly low during the disease progression and resumed to the original levels when patients recovered (pre-infection: 3.5 (3.0-4.4); on admission: 2.8 (2.3-3.1), p < 0.01; progression: 2.5 (2.3-3.0); discharge: 3.6 (2.7-4.1); median (IQR), in mmol/L). In non-surviving patients, LDL levels showed an irreversible and continuous decrease until death (1.1 (0.9-1.2), p = 0.02 versus the levels on admission). The ratio changes of LDL levels inversely correlated with ratio changes of high-sensitivity C-reactive protein levels. Logistic regression analysis showed increasing odds of lowered LDL levels associated with disease progression (odds ratio: 4.48, 95% IC: 1.55-12.92, p = 0.006) and in-hospital death (odds ratio: 21.72, 95% IC: 1.40-337.54, p = 0.028).
Conclusions: LDL levels inversely correlated to disease severities, which could be a predictor for disease progress and poor prognosis.
Keywords: COVID-19; LDL; Lipid; Odds ratio.
Copyright © 2020 Elsevier Inc. All rights reserved.
Conflict of interest statement
Declaration of competing interest The authors do not have any professional and financial affiliations that may be perceived to have biased the presentation.
Hypolipidemia is associated with the severity of COVID-19.J Clin Lipidol. 2020 Apr 30:S1933-2874(20)30078-7. doi: 10.1016/j.jacl.2020.04.008. Online ahead of print. J Clin Lipidol. 2020. PMID: 32430154 Free PMC article.
Higher low-density lipoprotein cholesterol levels are associated with decreased mortality in patients with intracerebral hemorrhage.Atherosclerosis. 2018 Feb;269:14-20. doi: 10.1016/j.atherosclerosis.2017.12.008. Epub 2017 Dec 6. Atherosclerosis. 2018. PMID: 29253643
Statins, high-density lipoprotein cholesterol, and regression of coronary atherosclerosis.JAMA. 2007 Feb 7;297(5):499-508. doi: 10.1001/jama.297.5.499. JAMA. 2007. PMID: 17284700
Molecular sources of residual cardiovascular risk, clinical signals, and innovative solutions: relationship with subclinical disease, undertreatment, and poor adherence: implications of new evidence upon optimizing cardiovascular patient outcomes.Vasc Health Risk Manag. 2013;9:617-70. doi: 10.2147/VHRM.S37119. Epub 2013 Oct 21. Vasc Health Risk Manag. 2013. PMID: 24174878 Free PMC article. Review.
Lipid Screening in Childhood and Adolescence for Detection of Familial Hypercholesterolemia: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet].Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Aug. Report No.: 14-05204-EF-2. Agency for Healthcare Research and Quality (US). 2016. PMID: 27559556 Free Books & Documents. Review.
- The species severe acute respiratory syndrome-related coronavirus: classifying 2019-NCOV and naming it SARS-COV-2. Nat Microbiol. 2020 doi: 10.1038/s41564-020-0695-z. - DOI
- Zhou P., Yang X.L., Wang X.G. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020 doi: 10.1038/s41586-020-2012-7. - DOI
- Wan Y., Shang J., Graham R. Receptor recognition by novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS. J Virol. 2020 doi: 10.1128/JVI.00127-20. - DOI