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Authors:Zhu et al. 

Journal/ Pre-Print:ResearchSquare 

Tags: Clinical, Metabolism 

Research Highlights

  1. HDL-C, ApoA1, LDL-C and cholesterol in COVID19 patient serum are associated with severity. 

  1. IL-6 and ApoA1 are independent risk factor predictor of severe disease outcome. 


Circulating lipid profiles are often changed upon viral infections, therefore the authors of this preprint sought to correlate changes in the lipidome of SARS-CoV-2 patients with disease severity. Zhu et al. use a retrospective cohort of 142 patients (incl. 17 severe cases) and a cohort of gender and age-matched 77 healthy individuals to identify crucial changes in the lipidome of SARS-CoV-2 infected individuals. The authors find an overall decrease of circulating cholesterol, high-density lipoprotein cholesterol (HDL-C) and its associated lipoprotein ApoA1, as well as low density lipoprotein (LDL). Furthermore, they find that IL-6 and ApoA1 can act as independent predictors of disease outcome after multivariant logistical analysis. The paper increases to an accumulating body of literature showing metabolic changes in severe COVID19 patients towards reduced HDL-C presence in severe patients which can be theoretically used as predictor or used as therapeutic target. 

Impact for SARS-CoV2/COVID19 research efforts  

Clinical symptoms and pathogenesis of SARS-Cov2/COVID19 

Changes in the lipidome are often observed in sepsis and viral infections with increasing disease severity. The reduced presence of HDL is generally associated to disease severity and can be used as a marker for disease progression/biomarker. It further allows future investigations in HDL/ApoA1 supplementation as anti-inflammatory treatment. 

Study Type  

  • Clinical Cohort study (Retrospective Patient Serum Study) 

Strengths and limitations of the paper 

Novelty: The study only provides limited novelty. Similar studies (Song et al., Li et al and others) have already characterized the lipidome of SARS-CoV-2 infected individuals and in parts to bigger detail. 

Interesting however is the confirmation that ApoA1 can act as independent predictor of disease severity showing in this cohort a way stronger predictive sensitivity and specificity as in comparison to Li et al.   

Standing in the fieldThe findings are largely confirmatory of previous reports. 

Appropriate statistics:Statistical testing seems appropriate, despite unbalanced group sizes  

(especially non-severe vs severe). 

Viral model used:Based on SARS-CoV-2 patients serum 

Translatability:The data is of interest for monitoring disease progression and may  

allow indeed (similar to other publications suggestions) to use HDL/ApoA1 as predictive marker for disease severity/mortality (see Li et al) 

Main limitations: The group sizes are fairly small especially as they are unbalanced between the groups (non-severe vs severe). 

The severe group has increased age and BMI in comparison to the non-severe patient group. It would have been interesting to use BMI as classifier and to compare disease groups accordingly with regards to their lipid profile as both age and BMI are known to impact on the lipidome in the blood. 

The authors did not refer to other preprints published on the same topic showing very similar results.