Background Dyslipidemia has been reported in patients with virus infections. This study was performed to evaluate the blood lipid profile in the patients with coronavirus disease 2019 (COVID-19), and exploring the underlying factors in its development and their predictive value for the severity of COVID-19.Methods In a case-control study, the lipid profile of patients with COVID-19 at the first admitted to two clinical centers in the west of Iran (July 2020 to Dec. 2020) and age- and gender-matched healthy people were explored. Three groups of controls, patients with the severe form of Covid-19 (admitted to the intensive care unit (ICU)), patients with Covid-19 with less intensity (outpatient admission), were defined for the subjects included in the study. The predictive values of different variables obtained from medical records for COVID-19 severity were analyzed.Results Generally, 48 outpatients and 49 ICU patients, including 70 men and 23 women with a mean age of 62.4±13.5 years, were included in the study. The control group consisted of 32 people, match sex and age with the patient groups. The mean triglyceride (TG) in the Covid-19 groups was higher than the control group, but there was no significant difference between them. The mean cholesterol in the patient groups was lower than the control group (p=0.001). The mean of low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) was significantly different in the patient groups; HDL-C in the ICU group was more than outpatient, and LDL-C in the outpatient group was more than ICU (P<0.05). LDL-C and HDL-C in the ICU group were less than the control group, but there was no statistically significant difference between the two mentioned groups. The frequency of diabetes and hypertension was higher in the ICU group than in the outpatient group (P<0.001). Furthermore, LDL-C level was associated with disease severity (odds ratio (OR): 0.966, 95% confidence interval (CI): 0.944-0.989, P= 0.004).Conclusion Lipid profiles in Covid-19 patients have different faces from healthy individuals. In the severe form, the lipid status has a different profile from the less severe form of Covid-19 disease. LDL-C level can be used as an indicator to determine the severity of Covid-19 disease.