Abstract
A number of studies have highlighted important alterations of the lipid profile in COVID-19 patients. Besides the well-known atheroprotective function, HDL displays anti-inflammatory, anti-oxidative, and anti-infectious properties. The aim of this retrospective study was to assess the HDL anti-inflammatory and antioxidant features, by evaluation of HDL-associated Serum amyloid A (SAA) enrichment and HDL-paraoxonase 1 (PON-1) activity, in a cohort of COVID-19 patients hospitalized at the Cardiorespiratory COVID-19 Unit of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan. COVID-19 patients reached very low levels of HDL-c (mean ± SD: 27.1 ± 9.7 mg/dL) with a marked rise in TG (mean ± SD: 165.9 ± 62.5 mg/dL). Compared to matched-controls, SAA levels were significantly raised in COVID-19 patients at admission. There were no significant differences in the SAA amount between 83 alive and 22 dead patients for all-cause in-hospital mortality. Similar findings were reached in the case of PON-1 activity, with no differences between alive and dead patients for all-cause in-hospital mortality. In conclusion, although not related to the prediction of in-hospital mortality, reduction in HDL-c and the enrichment of SAA in HDL are a mirror of SARS-CoV-2 positivity even at the very early stages of the infection.
Highlights
SARS-CoV-2 infection led to a dramatic drop in the levels of total cholesterol (TC) (−33%), low-density lipoprotein (LDL)-c (−37%), high-density lipoprotein (HDL)-c (−55%), and non-HDL-c (−24.5%), with a concomitant rise in the levels of TG (+42%)
In COVID-19 patients, we found that TG levels positively correlated with whole white blood cell count (β = 0.004, 95%confidence interval (CI) 0.0008;0.007, p = 0.0124), lymphocytes’
Several observational studies have found that low levels of TC, LDL-c, or HDL-c levels are associated with an increased risk of developing infections and sepsis [25,26,27]
Summary
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has already left a permanent mark on human history. SARS-CoV-2 infection associates to arterial hypertension [2] and cardiac injury, e.g., cases with and without classic coronary occlusion, arrhythmias, and heart failure [3]. Since the beginning of the pandemic, a number of studies have highlighted important alterations of the lipid profile in COVID-19 patients. With this respect, as in the case of other systemic inflammatory conditions, a decrease in total cholesterol (TC), low-density lipoprotein (LDL)-cholesterol (LDL-c), and high-density lipoprotein (HDL)-cholesterol (HDL-c) levels has been reported [8]. An alteration in bioactive lipids has been found during asymptomatic
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