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Cholesterol and Triglyceride Concentrations, COVID-19 Severity, and Mortality: A Systematic Review and Meta-Analysis
Angelo Zinellu1, Panagiotis Paliogiannis2,3, Alessandro G Fois2
1Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
Insights
Lower cholesterol levels in hospitalized COVID-19 patients correlate with severe disease and mortality. This systematic review highlights cholesterol as a potential marker for risk stratification in coronavirus disease 2019.
Area of Science:
- Biochemistry and Molecular Biology
- Infectious Diseases and Epidemiology
- Clinical Medicine
Background:
- Alterations in lipid profiles are noted in coronavirus disease 2019 (COVID-19) patients, with implications for disease severity and mortality.
- Understanding the relationship between lipid concentrations and COVID-19 outcomes is crucial for patient management and risk stratification.
Approach:
- A systematic review and meta-analysis with meta-regression was performed on 22 studies involving 10,122 hospitalized COVID-19 patients.
- Searched major databases (PubMed, Web of Science, Scopus) for studies reporting lipid profiles (total, HDL, LDL-cholesterol, triglycerides) and COVID-19 severity/survival.
- Analyzed pooled data to assess associations between lipid levels and disease severity or mortality, controlling for potential biases and confounders.
Key Points:
- Hospitalized patients with severe COVID-19 or non-survivor status exhibited significantly lower total cholesterol, LDL-cholesterol, and HDL-cholesterol concentrations.
- No significant association was found between triglyceride levels and COVID-19 severity or mortality.
- Meta-regression identified associations between LDL-cholesterol SMD and age/hypertension, and triglyceride SMD and study endpoint/aspartate aminotransferase.
Conclusions:
- Lower concentrations of total, HDL, and LDL-cholesterol are significantly associated with increased severity and mortality in COVID-19 patients.
- Cholesterol levels, alongside other clinical factors, may serve as valuable indicators for risk stratification and monitoring in COVID-19 management.
- Further research could explore the mechanistic links between lipid dysregulation and COVID-19 pathogenesis.
Abstract:
Lipid profile alterations have been observed in patients with coronavirus disease 2019 (COVID-19) in relation to disease severity and mortality. We conducted a systematic review and meta-analysis with meta-regression of studies reporting total, HDL, and LDL-cholesterol, and triglyceride concentrations in hospitalized patients with COVID-19. We searched PubMed, Web of Science and Scopus, between January 2020 and January 2021, for studies describing lipid concentrations, COVID-19 severity, and survival status (PROSPERO registration number: CRD42021253401). Twenty-two studies in 10,122 COVID-19 patients were included in the meta-analysis. Pooled results showed that hospitalized patients with severe disease or non-survivor status had significantly lower total cholesterol (standardized mean difference, SMD = -0.29, 95% CI -0.41 to -0.16, p < 0.001), LDL-cholesterol (SMD = -0.30, 95% CI -0.41 to -0.18, p < 0.001), and HDL-cholesterol (SMD = -0.44, 95% CI -0.62 to -0.26, p < 0.001), but not triglyceride (SMD = 0.04, 95% CI -0.10 to -0.19, p = 0.57), concentrations compared to patients with milder disease or survivor status during follow up. Between-study heterogeneity was large-to-extreme. In sensitivity analysis, the effect size of different lipid fractions was not affected when each study was in turn removed. The Begg's and Egger's t-tests did not show evidence of publication bias, except for studies investigating LDL-cholesterol. In meta-regression, significant associations were observed between the SMD of LDL-cholesterol and age and hypertension, and between the SMD of triglycerides and study endpoint and aspartate aminotransferase. In our systematic review and meta-analysis, lower total, HDL, and LDL-cholesterol, but not triglyceride, concentrations were significantly associated with COVID-19 severity and mortality. Cholesterol concentrations might be useful, in combination with other clinical and demographic variables, for risk stratification and monitoring in this group. Systematic Review Registration: PROSPERO registration number: CRD42021253401.
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