A decrease in low-density lipoprotein (LDL) levels may predict disease progression and poor prognosis in patients with coronavirus disease 2019 (COVID-19), according to study results published in Metabolism.

COVID-19 has been associated with an estimated mortality rate of approximately 2.3%. The goal of the current study was to assess the lipid pathophysiology in COVID-19.

The retrospective longitudinal analysis included 21 patients with laboratory-confirmed COVID-19 admitted to Zhongnan Hospital of Wuhan University in Wuhan, China between January 18 and February 8, 2020. Included patients had routine blood tests performed before admission for COVID-19 (between January 9 and 17, 2020), including assessment of the lipid profile. Control groups without COVID-19 included 31 healthy individuals and 21 patients with chronic obstructive pulmonary disease who had lipid tests performed in the same hospital.

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Most patients with COVID-19 had mild disease (62%), while 19% had a severe form of disease and a similar rate (19%) had critical disease according to the Chinese Center for Disease Control classifications. Of the 21 patients with COVID-19, 17 recovered and were discharged and 4 did not survive.

The researchers analyzed serum lipid levels prior to COVID-19 (baseline) and during the course of the disease. Median baseline LDL level was 3.5 mmol/L. These levels decreased significantly at the time of admission (median, 2.8 mmol/L; P <.01), remained relatively low during the treatment course (median, 2.5 mmol/L), and returned to near baseline levels by the time of discharge in patients who survived (median, 3.6 mmol/L). However, among those who did not survive, LDL levels showed a significant irreversible and continuous decrease until death (median, 1.1 mmol/L; P =.02).

High-density lipoprotein (HDL) levels also showed a significant decrease at the time of admission compared with baseline levels, but levels remained relatively low during the treatment and after recovery. Total cholesterol levels showed a similar pattern to LDL levels during the disease course.

Statistical analysis showed an association between lowered LDL levels and an increased risk for disease progression (odds ratio, 4.48; 95% CI, 1.55-12.92; P =.006) and in-hospital mortality (odds ratio, 21.72; 95% CI, 1.40-337.54; P =.028).

There was also a significant association between an increase in high-sensitivity C-reactive protein (hs-CRP) levels and disease severity in patients who survived COVID-19. In patients who did not survive, there was a continuous increase in hs-CRP levels until death. When the ratios of hs-CRP at each time point were normalized to the levels prior to infection in each patient, there was a significant inverse correlation between the ratios of hs-CRP with the ratios of LDL, HDL, and total cholesterol during the disease course.

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The researchers acknowledged several limitations of the study, including the small sample size, missing data on specific lipoproteins and oxidized LDLs, and no data on lipid profile patterns in patients without COVID-19 to determine the specificity of the association between LDL levels and COVID-19 severity.

“[O]ur results demonstrate that LDL decrease is associated with pathological course of COVID-19, which can serve a factor to access the disease progression and mortality,” concluded the researchers.

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Fan J, Wang H, Ye G, et al. Low-density lipoprotein is a potential predictor of poor prognosis in patients with coronavirus disease 2019 [published online April 19, 2020]. Metabolism. doi:10.1016/j.metabol.2020.154243