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Altered Lipid Profile Is a Risk Factor for the Poor Progression of COVID-19: From Two Retrospective Cohorts
Hui Jin1, Junji He2, Chuan Dong3
1Department of Otolaryngology, Wuhan Third Hospital, Wuhan, China.
Insights
Baseline lipid profile abnormalities are risk factors for poor COVID-19 prognosis. COVID-19 can alter lipid levels due to inflammation and organ damage, impacting disease outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Biochemistry
Background:
- The COVID-19 pandemic poses a global health challenge.
- The influence of baseline lipid profiles on COVID-19 clinical outcomes and the reciprocal effect of COVID-19 on lipid profiles remain underexplored.
Purpose of the Study:
- To investigate the association between baseline lipid profiles and clinical endpoints in COVID-19 patients.
- To examine how COVID-19 affects lipid profiles during the disease course.
Main Methods:
- A retrospective cohort study of 430 adult COVID-19 patients from two Chinese hospitals.
- Analysis of pre-admission and in-hospital lipid profiles, and clinical endpoints (in-hospital death, re-positive swab tests).
- Kaplan-Meier and Cox regression analyses were employed to identify lipid-related risk factors and assess changes in lipid levels.
Main Results:
- Low-density lipoprotein cholesterol (LDL-C) dyslipidemia was linked to a higher risk of re-positive oropharyngeal swabs post-discharge in Chengdu.
- Triglyceride (TG) dyslipidemia correlated with an increased risk of in-hospital death in Wuhan.
- Lipid levels decreased in patients experiencing in-hospital death or re-positive swabs.
- Biomarkers of inflammation (C-reactive protein) and impaired liver function (alanine aminotransferase) showed significant associations with lipid levels (TC).
Conclusions:
- Baseline dyslipidemia is a significant risk factor for adverse COVID-19 prognosis.
- COVID-19 can alter lipid metabolism, influenced by inflammation and organ damage.
- Lipid profile monitoring may be crucial for managing COVID-19 patients.
Background:
The coronavirus disease 2019 (COVID-19) pandemic has spread worldwide. However, the impact of baseline lipid profile on clinical endpoints in COVID-19 and the potential effect of COVID-19 on lipid profile remain unclear.
Methods:
In this retrospective cohort study, we consecutively enrolled 430 adult COVID-19 patients from two Chinese hospitals (one each in Chengdu and Wuhan). The lipid profile before admission and during the disease course and the clinical endpoint including in-hospital death or oropharyngeal swab test positive again (OSTPA) after discharge were collected. We used Kaplan-Meier and Cox regression to explore the lipid risk factors before admission associated with endpoints. Then, we assessed the lipid level change along with the disease course to determine the relationship between pathology alteration and the lipid change.
Results:
In the Chengdu cohort, multivariable Cox regression showed that low-density lipoprotein cholesterol (LDL-C) dyslipidemia before admission was associated with OSTPA after discharge for COVID-19 patients (RR: 2.51, 95% CI: 1.19, 5.29, p = 0.006). In the Wuhan cohort, the patients with triglyceride (TG) dyslipidemia had an increased risk of in-hospital death (RR: 1.92, 95% CI: 1.08, 3.60, p = 0.016). In addition, in both cohorts, the lipid levels gradually decreased in the in-hospital death or OSTPA subgroups since admission. On admission, we also noticed the relationship between the biomarkers of inflammation and the organ function measures and this lipid level in both cohorts. For example, after adjusting for age, sex, comorbidities, smoking, and drinking status, the C-reactive protein level was negatively associated with the TC lipid level [β (SE) = -0.646 (0.219), p = 0.005]. However, an increased level of alanine aminotransferase, which indicates impaired hepatic function, was positively associated with total cholesterol (TC) lipid levels in the Chengdu cohort [β (SE) = 0.633 (0.229), p = 0.007].
Conclusions:
The baseline dyslipidemia should be considered as a risk factor for poor prognosis of COVID-19. However, lipid levels may be altered during the COVID-19 course, since lipidology may be distinctly affected by both inflammation and organic damage for SARS-CoV-2.
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