Pre-infection HDL-cholesterol levels and mortality among elderly patients infected with SARS-CoV-2

Abstract

Background and aims Low HDL-cholesterol (HDLc) concentration is associated with a greater risk of infection-related mortality. We wanted to evaluate the relationship between pre-infection HDLc levels and mortality among older patients infected with SARS-Cov-2. Methods This is a population-based, cohort study, comprising all individuals residing in Madrid (Spain) born before 1 January 1945, and alive on 31 December 2019. Demographic, clinical, and analytical data were obtained from the primary care electronic clinical records. Confirmed SARS-CoV-2 infection was defined as a positive result in the RT-qPCR or in the antigen test. A death from COVID-19 was defined as that registered in the hospital chart, or as any death occurring in the 15 days following a confirmed SARS-CoV-2 infection. Data on infection, hospitalization, or death due to SAR-CoV-2 were collected from 1 March 2020 through 31 December 2020. Results Of the 593,342 individuals comprising the cohort, 36,966 had a SARS-CoV-2 infection during 2020, and at least one HDLc measurement in the previous five years. Among them, 9689 (26.2%) died from COVID-19. After adjustment for age and sex, the relative risk (95% confidence interval) of COVID-19 death across increasing quintiles of HDLc was 1.000, 0.896 (0.855–0.940), 0.816 (0.776–0.860), 0.758 (0.719–0.799), and 0.747 (0.708–0.787). The association was maintained after further adjustment for comorbidities, statin treatment and markers of malnutrition. While in females this association was linear, in males it showed a U-shaped curve. Conclusions In older subjects, a higher HDLc measured before SARS-CoV-2 infection was associated with a lower risk of death.

Prognostic significance of HDL-C on long-term mortality in patients with COVID-19 pneumonia in the Turkish population: A potential mechanism for population differences

“…Recombinant HDL-C therapy has become a new treatment for severe sepsis [ 14 ]. Patients with severe COVID-19 and mortality have been displayed to have lower HDL-C concentrations [ 15 ]. As society enters a post-COVID-19 era, the determinants of short- and long-term mortality from the first wave of COVID-19 are of interest.…”

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

“…Whether cause or a consequence of COVID-19 disease or how lipid metabolism is affected by the infection is not a question that could be answered by this cross-sectional study. Potential mechanisms related to COVID-19 dyslipidemia and few previous recently published studies also showed this association between low levels of HDL-c and the severity of COVID-19 pneumonia besides a protective factor against SARS-2 infection [ [6] , [9] , [33] , [34] , [35] , [36] , [37] ]. Previously to the SARS-Cov-2 pandemia it was pointed by several studies changes in the quantity and composition of HDL in infections and community acquired pneumonia.…”

Valor Prognóstico do Colesterol não HDL na Pneumonia por COVID-19

“…In the study by Mostaza et al, 41 which examined the prognostic effect of lipid levels before COVID-19 infection, an inverse association was found between a high HDL-C level and mortality in older individuals before the disease. 41 This is a similar status to our study. In another study by Masana et al, 42 serum lipid levels of 1305 patients were examined.…”