Low-density lipoprotein cholesterol levels are associated with poor clinical outcomes in COVID-19
MD Álvaro Aparisi, MD Carolina Iglesias-Echeverría, MD Cristina Ybarra-Falcón, MD, PhD Iván Cusácovich, MD Aitor Uribarri, MD Mario García-Gómez, MD Raquel Ladrón, Raúl Fuertes, MD Jordi Candela, MD Williams Hinojosa, MD Carlos Dueñas, MD, PhD Roberto González, MD Leonor Nogales, MD Dolores Calvo, MSc Manuel Carrasco-Moraleja, J Alberto San Román, MD, PhD Ignacio J Amat-Santos, MD, PhD David Andaluz-Ojeda
doi:10.1101/2020.10.06.20207092
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the sole causative agent of coronavirus infectious disease-19 .
Methods: We performed a retrospective single-center study of consecutively admitted patients between March 1 st and May 15 th, 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. Results: 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 with complete resolution among survivors. 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 < 1,000 (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.
Conclusion: Hypolipidemia in SARS-CoV-2 infection may be secondary to an immuneinflammatory response, with complete recovery in survivors. Low LDL-c serum levels are independently associated with higher 30-day mortality in COVID-19 patients.
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