Gong Jiao, Chen Yaqiong, Jie Yusheng, Tan Mingkai, Jiang Zhaofang, Yuan Lianxiong, Cao Jing, Li Ganwen, Chong Yutian, Qu Jiuxin, Shi Yaling, Hu Bo
Department of Laboratory Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Infectious Diseases, Key Laboratory of Liver Disease of Guangdong Province, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Front Cardiovasc Med. 2021 Aug 24;8:604736. doi: 10.3389/fcvm.2021.604736. eCollection 2021.
Low-density lipoprotein cholesterol (LDL-C) is a well-known risk factor for coronary heart disease but protects against infection and sepsis. We aimed to disclose the exact association between LDL-C and severe 2019 novel coronavirus disease (COVID-19). Baseline data were retrospectively collected for 601 non-severe COVID-19 patients from two centers in Guangzhou and one center in Shenzhen, and patients on admission were medically observed for at least 15 days to determine the final outcome, including the non-severe group ( = 460) and the severe group (severe and critical cases) ( = 141). Among 601 cases, 76 (12.65%) received lipid-lowering therapy; the proportion of patients taking lipid-lowering drugs in the severe group was higher than that in the non-severe group (22.7 vs. 9.6%). We found a -shaped association between LDL-C level and risk of severe COVID-19 using restricted cubic splines. Using univariate logistic regression analysis, odds ratios for severe COVID-19 for patients with LDL-C ≤1.6 mmol/L (61.9 mg/dL) and above 3.4 mmol/L (131.4 mg/dL) were 2.29 (95% confidence interval 1.12-4.68; = 0.023) and 2.02 (1.04-3.94; = 0.039), respectively, compared to those with LDL-C of 2.81-3.40 mmol/L (108.6-131.4 mg/dL); following multifactorial adjustment, odds ratios were 2.61 (1.07-6.37; = 0.035) and 2.36 (1.09-5.14; = 0.030). Similar results were yielded using 0.3 and 0.5 mmol/L categories of LDL-C and sensitivity analyses. Both low and high LDL-C levels were significantly associated with higher risk of severe COVID-19. Although our findings do not necessarily imply causality, they suggest that clinicians should pay more attention to lipid-lowering therapy in COVID-19 patients to improve clinical prognosis.
低密度脂蛋白胆固醇（LDL-C）是冠心病的一个众所周知的危险因素，但对感染和脓毒症具有保护作用。我们旨在揭示LDL-C与重症2019新型冠状病毒病（COVID-19）之间的确切关联。回顾性收集了来自广州两个中心和深圳一个中心的601例非重症COVID-19患者的基线数据，并对入院患者进行了至少15天的医学观察以确定最终结局，包括非重症组（n = 460）和重症组（重症和危重症病例）（n = 141）。在601例病例中，76例（12.65%）接受了降脂治疗；重症组服用降脂药物的患者比例高于非重症组（22.7%对9.6%）。我们使用受限立方样条发现LDL-C水平与重症COVID-19风险之间呈U形关联。使用单因素逻辑回归分析，与LDL-C为2.81 - 3.40 mmol/L（108.6 - 131.4 mg/dL）的患者相比，LDL-C≤1.6 mmol/L（61.9 mg/dL）和高于3.4 mmol/L（131.4 mg/dL）的患者发生重症COVID-19的比值比分别为2.29（95%置信区间1.12 - 4.68；P = 0.023）和2.02（1.04 - 3.94；P = 0.039）；经过多因素调整后，比值比分别为2.61（1.07 - 6.37；P = 0.035）和2.36（1.09 - 5.14；P = 0.030）。使用LDL-C的0.3和0.5 mmol/L类别以及敏感性分析也得出了类似结果。LDL-C水平过低和过高均与重症COVID-19的较高风险显著相关。尽管我们的研究结果不一定意味着因果关系，但它们表明临床医生应更加关注COVID-19患者的降脂治疗以改善临床预后。
