LOW HIGH-DENSITY LIPOPROTEIN LEVEL PROMOTES INFLAMMATORY RESPONSE IN LONG COVID PATIENTS UNDERGOING HEMODIALYSIS ONE YEAR AFTER INFECTION

Abstract

Objective: Long COVID, a syndrome characterized by persistent symptoms post-acute SARS-CoV-2 infection, poses unique challenges for patients undergoing hemodialysis (HD). Low levels of high-density lipoprotein (HDL) (<1.2 mmol/L) have been implicated in heightened COVID-19 risk and associated cardiovascular complications in this patient population. This study aimed to explore the potential association between low HDL and inflammatory responses in long COVID among HD patients. Design and method: A total of 80 hemodialysis (HD) patients, aged 55 (44-62.5) years, with a dialysis vintage of 45 (21-78.6) months and a history of COVID-19, were enrolled in this cross-sectional cohort study. Among them, 45 (56.2%) were diagnosed with long COVID, while 35 (43.8%) had fully recovered. Lipid profiles and inflammatory markers, such as serum interleukin (IL)-6, IL-17, and C-reactive protein (CRP), were assessed one year post-infection. The cytokines were measured using ELISA. Data were presented as median and interquartile interval [Me (Q25-Q75)] and compared using the Mann-Whitney test. Results: Patients experiencing long COVID exhibited significantly lower HDL levels compared to fully recovered individuals: 1.19 (1.06-1.76) vs 1.66 (1.32-1.92) mmol/L (p = 0.02). Among those with low HDL levels (<1.2 mmol/L), elevated concentrations of CRP, IL-6, and IL-17 were evident in comparison to patients with HDL concentrations exceeding 1.2 mmol/L (Fig. 1). Subsequent subgroup analysis revealed a more pronounced inflammatory profile in patients concurrently experiencing long COVID and exhibiting low HDL levels (Fig. 2). Conclusions: Our findings indicate that low HDL levels may enhance the inflammatory response in patients with long COVID undergoing HD one year post-infection, potentially promoting cardiovascular complications. Future research should focus on elucidating the pathways underlying this association and exploring novel strategies to mitigate inflammation and improve outcomes in long COVID among HD patients.