Changes in lipid metabolism in patients with severe COVID-19

Authors:Li et al. 

Link to paper:https://www.researchsquare.com/article/rs-43521/v1  

Journal/ Pre-Print:ResearchSquare 

Lipid metabolism is often dysregulated in severe pathologies including severe/critical viral infections. Li et al. describes a retrospective study of 216 patients (incl. 24 non-survivors) with a particular focus on major lipid serum components (cholesterol, lipoprotein complexes). The authors show that non-survivors present with significantly lower HDL levels (and ApoA1) levels at initial hospitalization and for the following several days compared with levels in survivors. HDL levels inversely correlate with disease severity and CRP levels. The ratio of CRP/HDL is a fairly good predictor for in-hospital mortality (AUC=0.823, Sensitivity=83.3%, Specificity=70.8%). This data confirms other reports of reduced HDL levels and suggests that changes in lipid metabolism (which are known to be present in obese) may worsen disease outcome.  

Impact for SARS-CoV2/COVID19 research efforts  

Clinical symptoms and pathogenesis of SARS-Cov2/COVID19 

This study shows that the non-survivors of COVID19 are dyslipidemic, a feature in obese individuals. The study shows that non-survivors have decreased HDL levels. The contribution of the dyslipidemia and whether changes in lipid metabolism can be used for therapy (e.g. to improve survival) remains unclear.  

Novelty: The study first suggests the ratio of CRP:HDL-C for predictor of critical  
SARS-CoV-2 patients. Further, the study follows the same patients in a longitudinal perspective (unfortunately with no data after release from the hospital).  

Standing in the field:Similar studies have been published showing specific decrease in  
lipoprotein particles including HDL (Song et al. 2020 Cell Metabolism) which have also been associated to reductions in circulating ApoA1 

Appropriate statistics:Yes, statistics seem to be appropriate. 

Viral model used:SARS-CoV-2 (patient cohort) 

Translatability:Using the identified ratio may be of help to clinicians as both  

parameters (HDL and CRP are routinely determined in a clinical setting) 

Main limitations: The study did not include a control cohort in order to see abnormal lipid profiles due to SARS-CoV-2 infection.  

Stratification by BMI or obesity as factor was unfortunately not investigated separately to further stratify lipid profiles. 

The study is performed as a retrospective study. It would have been ideal to use a prospective design to validate their CRP:HDL-C ratio to ensure the clinical applicability of this ratio as predictor.