Introduction
Methods
Study design and population
Endpoints
Data collection
Statistical analysis
Ethics
Results
COVID-19 patients have a decrease in cholesterol and its subfractions as well as an increase in triglycerides
Total (n = 1489) | Survivor (n = 1333) | Non-Survivor (n = 156) | Mild disease (n = 1362) | Severe disease (n = 127) | |||
---|---|---|---|---|---|---|---|
Number (%) | Number (%) | Number (%) | P value | Number (%) | Number (%) | P value | |
Age, mean (± SD), years | 66.83 ± 16.74 | 65.24 ± 16.47 | 80.35 ± 12.42 | <0.001 | 66.96 ± 17.03 | 65.34 ± 13.21 | 0.296 |
Male (n valid = 1489) | 810 (54.40) | 722 (54.16) | 88 (56.41) | 0.611 | 727 (53.38) | 83 (65.35) | 0.012 |
Female | 679 (45.60) | 611 (45.84) | 68 (43.59) | 635 (46.62) | 44 (34.65) | ||
Comorbidities | 1126 (75.62) | 980 (73.52) | 146 (93.59) | <0.001 | 1023 (75.11) | 103 (81.10) | 0.160 |
Non-Smoker (n valid = 1070) | 755/1070 (70.56) | 696/963 (72.27) | 59/107 (55.14) | 0.003 | 701/976 (71.82) | 54/94 (57.45) | 0.009 |
Smoker | 65/1070 (6.07) | 58/963 (6.02) | 7/107 (6.54) | 59/976 (6.05) | 6/94 (6.38) | ||
Ex-smoker | 250/1070 (23.36) | 209/963 (21.70) | 41/107 (38.32) | 216/976 (22.13) | 34/94 (36.17) | ||
Hypertension (n valid = 1489) | 684 (45.94) | 581 (43.59) | 103 (66.03) | <0.001 | 624 (45.81) | 60 (47.24) | 0.780 |
Hypercholesterolemia (n valid = 1489) | 566 (38.01) | 492 (36.91) | 74 (47.44) | 0.011 | 508 (37.30) | 58 (45.67) | 0.069 |
Hypertriglyceridemia (n valid = 1489) | 72 (4.84) | 62 (4.65) | 10 (6.41) | 0.324 | 60 (4.41) | 12 (9.45) | 0.017 |
Diabetes (n valid = 1489) | 307 (20.62) | 252 (18.90) | 55 (35.26) | <0.001 | 271 (19.90) | 36 (28.35) | 0.029 |
Cardiovascular disease (n valid = 1488) | 253/1488 (17.00) | 205/1332 (15.39) | 48/156 (30.77) | <0.001 | 237/1362 (17.40) | 16/126 (12.70) | 0.215 |
Cerebrovascular disease (n valid = 1488) | 237/1488 (15.93) | 190/1332 (14.26) | 47/156 (30.13) | <0.001 | 226/1361 (16.61) | 11/127 (8.66) | 0.022 |
Chronic pulmonary disease (n valid = 1489) | 309 (20.75) | 262 (19.65) | 47 (30.13) | 0.003 | 276 (20.26) | 33 (25.98) | 0.137 |
Chronic renal disease (n valid = 1489) | 113 (7.59) | 90 (6.75) | 23 (14.74) | 0.001 | 102 (7.49) | 11 (8.66) | 0.600 |
Chronic liver disease (n valid = 1488) | 80/1488 (5.38) | 71/1332 (5.33) | 9/156 (5.77) | 0.851 | 75/1361 (5.51) | 5/127 (3.94) | 0.679 |
Insulin treatment (n valid = 1489) | 76 (5.10) | 60 (4.5) | 16 (10.26) | 0.006 | 69 (5.07) | 7 (5.51) | 0.832 |
Statin treatment (n valid = 1489) | 437 (29.35) | 377 (28.28) | 60 (38.46) | 0.009 | 389 (28.56) | 48 (37.80) | 0.032 |
Fibrate treatment (n valid = 1489) | 33 (2.22) | 26 (1.95) | 7 (4.49) | 0.075 | 26 (1.91) | 7 (5.51) | 0.018° |
Survivor (n = 1333) | Non-survivor (n = 156) | Mild disease (n = 1362) | Severe disease (n = 127) | ||||
---|---|---|---|---|---|---|---|
Normal range | Median (IQR) | Number (IQR) | P value | Median (IQR) | Number (IQR) | P value | |
Peak red blood cells (N. x 1000 cells) | 3.80–4.80 | 4.93 (4.57–5.27) | 4.73 (4.25–5.04) | 0.000108 | 4.9 (4.52–5.25) | 4.96 (4.73–5.34) | 0.047400 |
Peak hemoglobin | 12.0–15.0 | 14.6 (13.5–15.6) | 13.7 (12.55–15) | 0.000016 | 14.6 (13.4–15.6) | 14.8 (13.8–15.9) | 0.040067 |
Peak hematocrit | 36.0–46.0 | 44.3 (41.4–47) | 42.6 (38.55–45.95) | 0.000461 | 43.9 (41.12–46.8) | 44.6 (42.4–47.6) | 0.047400 |
Peak platelets (N. x 1000 cells) | 150–450 | 343 (280–441) | 253 (194.5–372.5) | 0.000000 | 330 (268–428.75) | 387 (295–515) | 0.000533 |
Peak total leukocytes cells (N. x 1000 cells) | 4.00–10.00 | 10.07 (7.54–13.35) | 13.26 (9.19–19.54) | 0.000000 | 9.9 (7.38–13.13) | 16.16 (12.25–23.2) | 0.000000 |
Peak neutrophils (N. x 1000 cells) | 1.50–8.00 | 8.02 (5.27–11.1) | 11.19 (7.73–17.24) | 0.000000 | 7.87 (5.16–10.84) | 13.66 (10.73–19.89) | 0.000000 |
Peak lymphocytes (N. x 1000 cells) | 1.00–4.00 | 2.2 (1.69–2.83) | 1.35 (0.81–1.89) | 0.000000 | 2.13 (1.55–2.76) | 2.14 (1.53–2.83) | 0.988859 |
Peak monocytes (N. x 1000 cells) | 0.20–0.80 | 0.77 (0.61–1) | 0.71 (0.44–1.1) | 0.090782 | 0.75 (0.58–0.98) | 1.04 (0.8–1.37) | 0.000000 |
Peak eosinophils (N. x 1000 cells) | 0.20–0.50 | 0.2 (0.12–0.33) | 0.09 (0.02–0.23) | 0.000000 | 0.19 (0.11–0.31) | 0.27 (0.13–0.56) | 0.000857 |
Peak basophils (N. x 1000 cells) | 0.00–0.20 | 0.05 (0.03–0.07) | 0.03 (0.02–0.06) | 0.000169 | 0.05 (0.03–0.07) | 0.07 (0.04–0.11) | 0.000002 |
Peak ESR | 0.0–25.00 | 45 (25–70) | 69 (51–83) | 0.000004 | 47 (26–72) | 50.5 (28–74) | 0.542465 |
Peak D dimer | 0.15–0.50 | 1.04 (0.59–2.18) | 5.66 (1.68–18.45) | 0.000000 | 1.05 (0.6–2.19) | 5.14 (1.77–18.2) | 0.000000 |
Peak fibrinogen | 150–400 | 765 (663.75–872.25) | 779.5 (667–955.75) | 0.207711 | 758.5 (652.75–863.25) | 882 (763.25–1006.5) | 0.000000 |
Peak T-c | 150–200 | 205 (174–235) | 165.5 (138–195.5) | 0.000000 | 199 (169–230) | 229 (184.25–263.75) | 0.000066 |
Peak TG | 50–200 | 162 (118–228) | 163.5 (119–247) | 0.557804 | 157 (114–214) | 283 (186.5–403) | 0.000000 |
Valley HDL-c | ≥65 | 46 (35–60) | 31 (22.5–46.5) | 0.000016 | 47 (36–60) | 34 (24–46) | 0.000000 |
Valley LDL-c | ≤130 | 130 (110–149) | 106 (66–133) | 0.003386 | 130 (108–148.25) | 128.5 (107.25–146) | 0.751943 |
Peak random blood glucose | 74–106 | 142 (118–180) | 173 (140–229.5) | 0.000000 | 141 (118–177) | 197 (158–288) | 0.000000 |
Peak HbA1c | 4.0–5.7 | 6 (5.7–6.7) | 6.8 (5.85–7.4) | 0.130892 | 6 (5.7–6.7) | 6.3 (5.8–6.9) | 0.316584 |
Valley albumin | 3.5–5.2 | 3.5 (3.2–3.9) | 3.2 (2.8–3.5) | 0.000000 | 3.5 (3.2–3.9) | 3 (2.8–3.4) | 0.000000 |
Valley prealbumin | 20.00–40.00 | 20.86 (14.62–29.11) | 13 (8.22–34.18) | 0.573891 | 19.14 (12.67–26.13) | 26.15 (17.12–36.88) | 0.002552 |
Peak creatinine | 0.50–0.90 | 0.99 (0.82–1.21) | 1.27 (0.94–2.01) | 0.000000 | 1 (0.83–1.23) | 1.09 (0.85–1.5) | 0.012779 |
Peak blood urea | 16.6–48.5 | 47 (36–65) | 90 (63–132) | 0.000000 | 47 (36–66) | 74 (55–98) | 0.000000 |
Peak AST | 4–32 | 50 (34–79) | 62 (41–97) | 0.003386 | 49 (33–77) | 77 (53–116) | 0.000000 |
Peak ALT | 5–33 | 59 (34–105) | 44 (25–107) | 0.014899 | 54 (32–97) | 119 (73–203) | 0.000000 |
Peak ferritin | 15–150 | 956 (442.5–1758.5) | 1525 (889–2848) | 0.000016 | 945 (437.25–1752.25) | 1655 (1119.5–2702.5) | 0.000000 |
Peak IL-6 | 14.81 (3.69–44.24) | 68.5 (21–197.89) | 0.000000 | 13.28 (3.65–37.6) | 87 (21.5–336.54) | 0.000000 | |
Peak LDH | 135–214 | 325 (264–411.75) | 530 (422–752) | 0.000000 | 324 (263.25–412) | 563 (435–727) | 0.000000 |
Peak hsRCP | 0.00–0.50 | 9.77 (5.12–16.97) | 19.32 (12.25–30.45) | 0.000000 | 9.86 (5.12–16.85) | 20.11 (11.57–30.34) | 0.000000 |
Peak IgG | 800–1600 | 1060 (864.5–1240) | 953 (768.5–1165) | 0.057210 | 1055 (865.75–1250) | 1010 (803.25–1180) | 0.066501 |
Peak IgA | 100–300 | 250 (174.5–334) | 275 (192.5–352.5) | 0.207711 | 260 (178–339) | 220 (169–309.5) | 0.099928 |
Peak IgM | 80–250 | 97.5 (73.97–141) | 102 (59–140) | 0.573891 | 98 (73.55–141) | 94.9 (60.65–140.75) | 0.640211 |
Peak C3 | 80–140 | 125 (109–143) | 108 (102–126) | 0.006473 | 124.5 (107.75–143) | 124.5 (108.25–137.75) | 0.714261 |
Peak C4 | 12–33 | 29 (21.8–35.6) | 27.4 (23.4–36.1) | 0.573891 | 29.15 (21.68–35.75) | 28.35 (23.15–34.57) | 0.751943 |
Peak procalcitonin | 0.05–0.09 | 0.15 (0.09–0.32) | 0.48 (0.19–1.48) | 0.000000 | 0.15 (0.08–0.31) | 0.38 (0.19–1.43) | 0.000000 |
Relation of lipid profile with comorbidities and previous therapies
Effect of different therapies used during hospitalization on lipid profile
Hydroxychloroquine | ||||
---|---|---|---|---|
Timea | No | Yes | Interaction P-valueb | |
T-c (mg/dL) | Pre | 163.62 ± 30.95 | 169.98 ± 46.20 | 0.44198 |
Pos | 161.78 ± 35.01 | 157.89 ± 40.99 | ||
HDL-c (mg/dL) | Pre | 56.20 ± 6.06 | 52.61 ± 20.81 | 0.43691 |
Pos | 37.27 ± 11.65 | 41.57 ± 17.03 | ||
LDL-c (mg/dL) | Pre | 68.80 ± 31.09 | 113.95 ± 37.03 | 0.05 |
Pos | 119.78 ± 36.99 | 117.63 ± 41.59 | ||
TG (mg/dL) | Pre | 125.79 ± 55.85 | 166.77 ± 148.84 | 0.0514 |
Pos | 161.97 ± 87.98 | 167.83 ± 99.74 | ||
LPV/r | ||||
Timea | No | Yes | Interaction P-valueb | |
T-c (mg/dL) | Pre | 163.36 ± 43.02 | 173.82 ± 45.66 | 0.6885 |
Pos | 153.36 ± 41.99 | 160.59 ± 39.71 | ||
HDL-c (mg/dL) | Pre | 52.50 ± 14.54 | 53.55 ± 23.10 | 0.624159 |
Pos | 42.64 ± 17.12 | 40.27 ± 16.23 | ||
LDL-c (mg/dL) | Pre | 108.50 ± 37.82 | 106.37 ± 41.43 | 0.496 |
Pos | 127.48 ± 38.45 | 113.57 ± 41.49 | ||
TG (mg/dL) | Pre | 135.17 ± 70.62 | 173.44 ± 175.62 | 0.1368 |
Pos | 160.68 ± 82.42 | 171.49 ± 108.50 | ||
Methylprednisolone | ||||
Timea | No | Yes | Interaction P-valueb | |
T-c (mg/dL) | Pre | 175.62 ± 45.52 | 166.84 ± 44.33 | 0.32231 |
Pos | 158.23 ± 40.01 | 158.12 ± 40.92 | ||
HDL-c (mg/dL) | Pre | 59.17 ± 22.57 | 51.19 ± 18.47 | 0.106861 |
Pos | 37.50 ± 15.64 | 42.27 ± 16.69 | ||
LDL-c (mg/dL) | Pre | 125.33 ± 32.54 | 100.82 ± 40.06 | 0.0815 |
Pos | 112.07 ± 45.69 | 120.36 ± 38.79 | ||
TG (mg/dL) | Pre | 129.97 ± 57.36 | 158.67 ± 140.82 | 0.4884 |
Pos | 155.61 ± 60.64 | 171.70 ± 110.66 | ||
Dexamethasone | ||||
Timea | No | Yes | Interaction P-valueb | |
T-c (mg/dL) | Pre | 170.09 ± 46.01 | 162.74 ± 32.92 | 0.7449 |
Pos | 158.90 ± 40.60 | 147.16 ± 39.40 | ||
HDL-c (mg/dL) | Pre | 53.97 ± 20.02 | 45.50 ± 13.92 | 0.441664 |
Pos | 40.99 ± 16.75 | 41.67 ± 13.04 | ||
LDL-c (mg/dL) | Pre | 105.74 ± 40.04 | 116.40 ± 37.35 | 0.814 |
Pos | 116.95 ± 41.24 | 134.38 ± 32.51 | ||
TG (mg/dL) | Pre | 150.12 ± 128.51 | 139.08 ± 60.39 | 0.7187 |
Pos | 166.70 ± 100.03 | 163.31 ± 81.15 | ||
Tocilizumab | ||||
Timea | No | Yes | Interaction P-valueb | |
T-c (mg/dL) | Pre | 169.25 ± 44.25 | 169.30 ± 47.72 | 0.59407 |
Pos | 157.09 ± 41.00 | 162.72 ± 38.67 | ||
HDL-c (mg/dL) | Pre | 53.19 ± 20.91 | 52.50 ± 10.01 | 0.54881 |
Pos | 42.84 ± 16.58 | 36.91 ± 15.74 | ||
LDL-c (mg/dL) | Pre | 112.77 ± 39.85 | 81.83 ± 25.90 | 0.234 |
Pos | 119.29 ± 43.34 | 113.56 ± 32.44 | ||
TG (mg/dL) | Pre | 149.53 ± 121.54 | 131.50 ± 61.20 | 0.0477a |
Pos | 160.87 ± 85.36 | 198.29 ± 143.83 |
Variations of lipid profile, albumin, and inflammatory markers in relation with severity of the disease
Decrease in total cholesterol and its fractions and increase in TG levels are prognostic factors for disease progression
Lipid profile findings | ICU admission | |
---|---|---|
HRa | (95% CI) | |
Pre-ICU T-c (50 mg/dL variation) | 0.55 | (0.36–0.86) |
Pre-ICU HDL-C values (10 mg/dL variation) | 0.61 | (0.45–0.84) |
Pre-ICU LDL-C values (10 mg/dL variation) | 0.85 | (0.74–0.97) |
Pre-ICU TG values (100 mg/dL variation) | 1.07 | (0.94–1.23) |
Mortality | ||
Max T-c (50 mg/dL variation) | 0.45 | (0.36–0.57) |
Max HDL-C values (10 mg/dL variation) | 0.66 | (0.54–0.81) |
Max LDL-C values (10 mg/dL variation) | 0.86 | (0.78–0.94) |
Max TG values (100 mg/dL variation) | 0.94 | (0.81–1.09) |