Low HDL-c levels at admission are associated with greater severity and worse clinical outcomes in patients with COVID-19 disease.

Background And Aims: HDL particles may act to buffer host cells from excessive inflammatory mediators. The aim of this study is to investigate if the lipid profile provides a prognostic biomarker for COVID-19 outcomes.

Methods: This was a prospective study of the characteristics of 125 adult COVID-19 patients with a lipid profile performed on the day of admission analyzed with regard to clinical outcomes.

Results: Seventy-seven patients (61.2%) were men, with a mean age of 66.3 (15.6) years. 54.1% had bilateral pneumonia. The all-cause mortality rate during hospitalization was 20.8%. We found a direct association between more severe disease assessed by the WHO classification, admission to the ICU and death with more pronounced lymphopenia, higher levels of CRP, ferritin ( < 0.001), D-dímer and lactate dehydrogenase (LDH) all statistically significant. Lower leves of HDL-c and LDL-c were also associated with a worse WHO classification, ICU admission, and death,. HDL-c levels were inversely correlated with inflammatory markers CRP ( = -0.333;  < 0.001), ferritin ( = -0.354;  < 0.001), D-dímer ( = -0.214;  < 0.001), LDH ( = -0.209;  < 0.001. LDL-c levels were significantly associated with CRP ( = -0.320;  < 0.001) and LDH ( = -0.269;  < 0.001). ROC curves showed that HDL [AUC = 0.737(0.586-0.887),  = 0.005] and lymphocytes [AUC = 0.672(0.497-0.847],  < 0.043] had the best prognostic accuracy to predict death. In a multivariate analysis, HDL-c (β = -0.146(0.770-0.971),  = 0.014) and urea (β = 0.029(1.003-1.057),  = 0.027) predicted mortality.

Conclusion: Hypolipidemia including HDL levels at admission identifies patients with a higher risk of death and worse clinical manifestations who may require more intensive care.