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

Highlights

• Coronavirus disease 2019 (COVID-19) is associated with decreased circulating levels of lipids.

• We observed a reversible U-pattern among survivors, this has already been described in other autoimmune or inflammatory conditions.

• Low LDL-c levels are associated with higher risk of mortality and could be useful for better risk stratification of COVID-19 patients.

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.