Low-density lipoprotein cholesterol levels are associated with poor clinical outcomes in COVID-19
Open accessPublished version of a preprint
Abstract
Background and aims Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the sole causative agent of coronavirus infectious disease-19 (COVID-19).Methods and results We performed a retrospective single-center study of consecutively admitted patients between March 1st and May 15th, 2020, with a definitive diagnosis of SARS-CoV-2 infection. The primary end-point was to evaluate the association of lipid markers with 30-days all-cause mortality in COVID-19. A total of 654 patients were enrolled, with an estimated 30-day mortality of 22.8% (149 patients). Non-survivors had lower total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-c) levels during the entire course of the disease. Both showed a significant inverse correlation with inflammatory markers and a positive correlation with lymphocyte count. In a multivariate analysis, LDL-c ≤ 69 mg/dl (hazard ratio [HR] 1.94; 95% confidence interval [CI] 1.14-3.31), C-reactive protein >88 mg/dl (HR 2.44; 95% CI, 1.41-4.23) and lymphopenia <1000 (HR 2.68; 95% CI, 1.91-3.78) at admission were independently associated with 30-day mortality. This association was maintained 7 days after admission. Survivors presented with complete normalization of their lipid profiles on short-term follow-up.Conclusion Hypolipidemia in SARS-CoV-2 infection may be secondary to an immune-inflammatory response, with complete recovery in survivors. Low LDL-c serum levels are independently associated with higher 30-day mortality in COVID-19 patients.
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Cholesterol is a principal component of the cell membrane and plays an important role in synaptic functions, and the depletion of cholesterol may induce the alteration of brain signaling, with effects on several neurotransmission systems.
“Cholesterol is a principal component of the cell membrane and plays an important role in synaptic functions, and the depletion of cholesterol may induce the alteration of brain signaling, with effects on several neurotransmission systems (48, 52).”
From Investigation of systemic immune-inflammation index, neutrophil/high-density lipoprotein ratio, lymphocyte/high-density lipoprotein ratio, and monocyte/high-density lipoprotein ratio as indicators of inflammation in patients with schizophrenia and bipolar disorder (2022) · cites this paper as [52]
The Introduction (page not provided) says cholesterol is an essential constituent of cell membranes that facilitates signal transduction. It does not address synaptic function or say that cholesterol depletion alters brain signaling or neurotransmission; searches for those terms found no supporting passage. (LLM, conf=0.88)
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- Authors
- Aparisi, Á., Iglesias-Echeverría, C., Ybarra-Falcón, C., Cusácovich, I., Uribarri, A., García-Gómez, M., Ladrón, R., Fuertes, R., Candela, J., Tobar, J., Hinojosa, W., Dueñas, C., González, R., Nogales, L., Calvo, D., Carrasco-Moraleja, M., San Román, J. A., Amat-Santos, I. J., & Andaluz-Ojeda, D.
- Affiliations
- Hospital Clínico Universitario de Valladolid (ES)
- Universidad de Valladolid (ES)
- Centro de Investigación en Red en Enfermedades Cardiovasculares (ES)
- ORCID
- Venue
- Nutrition, Metabolism and Cardiovascular Diseases
- Publisher
- Elsevier BV
- Published
- 2021-08
- Volume
- 31
- Issue
- 9
- Pages
- 2619-2627
- ISSN
- 0939-4753 (ISSN-L)
- PMC
- PMC8259049
- OpenAlex
- W3179592424
- Cited by
- 48
- References
- 34
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 8 · 2023: 8 · 2022: 16 · 2021: 8
- FWCI
- 3.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Nutrition Metabolism and Cardiovascular Diseases (publishedVersion)
- medRxiv (acceptedVersion, public-domain)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- COVID-19 pandemic, SARS-CoV-2, LDL cholesterol, hypolipidemia, 30-day mortality, total cholesterol, C-reactive protein, lymphopenia, inflammation, lipid biomarkers, prognostic factors
- MeSH terms
- COVID-19, Aged, Aged, 80 and over, Female, Humans, Cholesterol, LDL, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Spain, Time Factors, Biomarkers, Down-Regulation, Risk Assessment, Inflammation Mediators, Dyslipidemias
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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