Lipid Profile Features and Their Associations With Disease Severity and Mortality in Patients With COVID-19.
Lipid Profile Features and Their Associations With Disease Severity and Mortality in Patients With COVID-19.
复制标题
COVID-19 患者的血脂特征及其与疾病严重程度和死亡率的关系
DOI：
10.3389/fcvm.2020.584987
复制
发表时间：
2020
影响因子：
3.6
通讯作者：
Pu J
中科院分区：
文献类型：
--
作者：
Sun JT;Chen Z;Nie P;Ge H;Shen L;Yang F;Qu XL;Ying XY;Zhou Y;Wang W;Zhang M;Pu J
背景：新兴研究描述和分析了COVID-19患者的流行病学、临床、实验室和放射学特征。然而，关于血脂特征与疾病严重程度和死亡率之间的关系的信息很少。方法：我们进行了一项前瞻性观察性队列研究，以调查COVID-19患者的血脂特征。2020年2月9日至4月4日，共有99名确诊COVID-19的患者（31名危重患者和20名重症患者）纳入研究。记录并跟踪血脂谱的动态变化。结果随访至2020年4月4日。结果如下：我们发现，高密度脂蛋白胆固醇（HDL-C）和载脂蛋白A-1（apoA-1）水平在重症组中明显较低，死亡病例显示出最低水平（p <0.0001）。此外，HDL-C和apoA-1水平与疾病严重程度独立相关（apoA-1：比值比（OR）：0.651，95%置信区间（CI）：0.456 - 0.929，p = 0.018; HDL-C：OR：0.643，95% CI：0.456 - 0.906，p = 0.012）。对于预测疾病严重程度，入院时HDL-C和apoA-1水平的受试者工作特征曲线下面积（AUC）分别为0.78（95%CI，0.70 - 0.85）和0.85（95%CI，0.76 - 0.91）。对于院内死亡，HDL-C和apoA-1水平显示出相似的区分能力，AUC分别为0.75（95% CI，0.61 - 0.88）和0.74（95% CI，0.61 - 0.88）。此外，血清apoA-1（<0.95 g/L）或HDL-C（<0.84 mmol/L）浓度较低的患者住院期间的死亡率较高（对数秩p <0.001）。值得注意的是，apoA-1和HDL-C水平与疾病严重程度成反比。严重病例的存活者在住院结束时显示出apoA-1水平的显著恢复（与中期apoA-1水平相比，p = 0.02），而死亡病例在整个住院期间显示出持续较低的apoA-1水平。相关分析显示，apoA-1和HDL-C水平与入院水平和C-反应蛋白和白细胞介素-6的最高浓度呈负相关。结论：重症COVID-19患者的HDL-C和apoA-1水平较低，与炎症状态密切相关。因此，低apoA-1和HDL-C水平可能是患有COVID-19的患者的严重疾病和住院死亡率的有希望的预测因子。
Background: Emerging studies have described and analyzed epidemiological, clinical, laboratory, and radiological features of COVID-19 patients. Yet, scarce information is available regarding the association of lipid profile features and disease severity and mortality. Methods: We conducted a prospective observational cohort study to investigate lipid profile features in patients with COVID-19. From 9 February to 4 April 2020, a total of 99 patients (31 critically ill and 20 severely ill) with confirmed COVID-19 were included in the study. Dynamic alterations in lipid profiles were recorded and tracked. Outcomes were followed up until 4 April 2020. Results: We found that high-density lipoprotein-cholesterol (HDL-C) and apolipoprotein A-1 (apoA-1) levels were significantly lower in the severe disease group, with mortality cases showing the lowest levels (p < 0.0001). Furthermore, HDL-C and apoA-1 levels were independently associated with disease severity (apoA-1: odds ratio (OR): 0.651, 95% confidence interval (CI): 0.456–0.929, p = 0.018; HDL-C: OR: 0.643, 95% CI: 0.456–0.906, p = 0.012). For predicting disease severity, the areas under the receiver operating characteristic curves (AUCs) of HDL-C and apoA-1 levels at admission were 0.78 (95% CI, 0.70–0.85) and 0.85 (95% CI, 0.76–0.91), respectively. For in-hospital deaths, HDL-C and apoA-1 levels demonstrated similar discrimination ability, with AUCs of 0.75 (95% CI, 0.61–0.88) and 0.74 (95% CI, 0.61–0.88), respectively. Moreover, patients with lower serum concentrations of apoA-1 (<0.95 g/L) or HDL-C (<0.84 mmol/l) had higher mortality rates during hospitalization (log-rank p < 0.001). Notably, levels of apoA-1 and HDL-C were inversely proportional to disease severity. The survivors of severe cases showed significant recovery of apoA-1 levels at the end of hospitalization (vs. midterm apoA-1 levels, p = 0.02), whereas the mortality cases demonstrated continuously lower apoA-1 levels throughout hospitalization. Correlation analysis revealed that apoA-1 and HDL-C levels were negatively correlated with both admission levels and highest concentrations of C-reactive protein and interleukin-6. Conclusions: Severely ill COVID-19 patients featured low HDL-C and apoA-1 levels, which were strongly correlated with inflammatory states. Thus, low apoA-1 and HDL-C levels may be promising predictors for severe disease and in-hospital mortality in patients suffering from COVID-19.