Low LDL, high triglycerides could indicate COVID-19 mortality risk
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Among patients hospitalized with COVID-19, LDL level below 50 mg/dL and triglycerides above 150 mg/dL were individually associated with increased odds for mortality, according to a presentation.
“Prior studies have demonstrated lipid abnormalities in patients with SARS-CoV-2 that were mainly analyzing total cholesterol levels. Our study suggests that patients with COVID-19 who have unusually low LDL levels and yet elevated TG levels have more increased mortality,” Karolyn Teufel MD, assistant professor of medicine at the George Washington University Hospital in Washington D.C., and colleagues wrote in a poster presented at the virtual National Lipid Association Scientific Sessions. “These lipid biomarkers may act as an independent prognostic marker for patients on admission. Additionally, it is unusual to see low LDL and high TG in a patient with metabolic syndrome — one would expect to see elevated LDL levels in such patients.”
This retrospective analysis included 254 patients hospitalized with COVID-19 (mean age, 62 years; 54% men; 70% Black) who underwent random lipid measurements performed during their stay at the George Washington University Hospital. The researchers evaluated the association between lipid biomarkers and mortality among patients hospitalized with COVID-19.
At this hospital, the lower limit of normal LDL range is 50 mg/dL, the lower limit for HDL is 40 mg/dL, and the upper limit for triglycerides is 150 mg/dL.
Researchers observed greater odds for mortality when the direct LDL was below 50 mg/dL at any point during a patient’s hospital stay (OR = 3.73; 95% CI, CI 1.85-7.51).
In an analysis of triglyceride levels and mortality during COVID-19 hospitalization, researchers found increased likelihood of death when the maximum triglyceride level was greater than 150 mg/dL during a patient’s stay (OR = 4.32; 95% CI 2.35-7.97).
Moreover, HDL lower than 40 mg/dL showed a trend for increased mortality but was not statistically significant.
“The combination of low LDL and high TG levels are particularly concerning,” Teufel and colleagues wrote. “And high TG levels associated with low HDL, although the latter did not reach significance, indicates presence of metabolic syndrome at a baseline for our subjects. Our findings add to current literature that continues to show both metabolic syndrome and obesity are risk factors for severe COVD-19.”
In other findings, researchers observed no association between statin use and mortality, with a similar proportion of statin and non-statin users dying (22% vs. 22%; P = .98).
According to the poster presentation, statin use was also not associated with mortality in COVID-19 when analyzed among subgroups of patients with LDL above or below 50 mg/dL.
“Future studies would further compare lipid biomarkers on a longer longitudinal timeline, as well as multivariate analysis to investigate the role of other conditions and biomarkers in conjunction with these lipid abnormalities in COVID-19 infection,” Teufel and colleagues wrote.
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Teufel K, et al. Abstract 268. Presented at: National Lipid Association Scientific Sessions; Dec. 10-12, 2020 (virtual meeting).
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