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

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

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 < 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. 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.