Eleveated triglycerides predict increased mortality in patients with severe COVID-19 - An observational study

Dyslipidemia is common in severe COVID-19, but the prognostic significance of standard lipid parameters remains incompletely defined. Because severe COVID-19 frequently fulfills Sepsis-3 criteria, this setting also provides a relatively homogeneous model of viral sepsis.

To assess the associations of standard serum lipid parameters with mortality in hospitalized patients with severe COVID-19.

In this prospective observational cohort study, 191 adults with polymerace chain reaction (PCR)-confirmed COVID-19 admitted to Karolinska University Hospital, Stockholm, Sweden, during March to October 2020 were included. Serum total cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein-cholesterol, triglycerides, apolipoprotein A1 (ApoA1), apolipoprotein B, and lipoprotein(a) were analyzed in samples obtained a median of 5 days after hospital admission. Associations with mortality were evaluated using stepwise Cox regression with adjustment for age, sex, body mass index, time to inclusion, cumulative dexamethasone dose, D-dimer, C-reactive protein, lactate dehydrogenase, creatinine, and sedation status.

Overall, 24 patients (12.6%) died, and 77% fulfilled Sepsis-3 criteria. Nonsurvivors had higher triglycerides than survivors (3.2 vs 2.1 mmol/L; P = .002), whereas HDL-cholesterol and ApoA1 were lower. Triglycerides were the strongest independent laboratory predictor of mortality in the fully adjusted model (hazard ratio per 1 mmol/L increase, 1.18; 95% CI, 1.00-1.39; P = .044).

Elevated triglycerides were independently associated with mortality in severe COVID-19. These findings support triglycerides as an accessible prognostic biomarker in severe COVID-19 with viral sepsis phenotype, while extrapolation to other forms of sepsis requires further study.