Chinese Medical Sciences Journal ›› 2021, Vol. 36 ›› Issue (1): 17-26.doi: 10.24920/003866

• Original Article • Previous Articles     Next Articles

Association Analysis of Hyperlipidemia with the 28-Day All-Cause Mortality of COVID-19 in Hospitalized Patients

Bin Wu1, Jianghua Zhou1, 2, Wenxin Wang1, 2, Huilin Yang2, 3, Meng Xia2, Binghong Zhang4, Zhigang She1, 2, Hongliang Li1, 2, 3, 5, *()   

  1. 1Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430071, China
    2Institute of Model Animal, Wuhan University, Wuhan 430071, China
    3Basic Medical School, Wuhan University, Wuhan 430071, China
    4Department of Neonatology, Renmin Hospital of Wuhan University, Wuhan 430072, China
    5Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
  • Received:2021-02-09 Accepted:2021-03-05 Published:2021-03-17 Online:2021-03-17
  • Contact: Hongliang Li
In a cohort of 10 945 hospitalized patients with COVID-19 from Hubei Province, China, Wu et al. found that hyperlipidemia was not significantly associated with an increased risk of 28-day all-cause COVID-19 mortality. This association remained non-significant even in the subgroup analyses on patients with cardiovascular diseases or diabetes. They also found that none of the specific lipid parameters, including TG, LDL-C, and HDL-C, was significantly correlated with 28-day all-cause mortality in this COVID-19 cohort.

Objective This study aimed to determine the association of hyperlipidemia with clinical endpoints among hospitalized patients with COVID-19, especially those with pre-existing cardiovascular diseases (CVDs) and diabetes.

Methods This multicenter retrospective cohort study included all patients who were hospitalized due to COVID-19 from 21 hospitals in Hubei province, China between December 31, 2019 and April 21, 2020. Patients who were aged < 18 or ≥ 85 years old, in pregnancy, with acute lethal organ injury (e.g., acute myocardial infarction, severe acute pancreatitis, acute stroke), hypothyroidism, malignant diseases, severe malnutrition, and those with normal lipid profile under lipid-lowering medicines (e.g., statin, niacin, fenofibrate, gemfibrozil, and ezetimibe) were excluded. Propensity score matching (PSM) analysis at 1:1 ratio was performed to minimize baseline differences between patient groups of hyperlipidemia and non-hyperlipidemia. PSM analyses with the same strategies were further conducted for the parameters of hyperlipidemia in patients with increased triglyceride (TG), increased low-density lipoprotein cholesterol (LDL-C), and decreased high-density lipoprotein cholesterol (HDL-C). Mixed-effect Cox model analysis was performed to investigate the associations of the 28-days all-cause deaths of COVID-19 patients with hyperlipidemia and the abnormalities of lipid parameters. The results were verified in male, female patients, and in patients with pre-existing CVDs and type 2 diabetes.

Results Of 10 945 inpatients confirmed as COVID-19, there were 9822 inpatients included in the study, comprising 3513 (35.8%) cases without hyperlipidemia and 6309 (64.2%) cases with hyperlipidemia. Based on a mixed-effect Cox model after PSM at 1:1 ratio, hyperlipidemia was not associated with increased or decreased 28-day all-cause death [adjusted hazard ratio (HR), 1.17 (95% CI, 0.95-1.44), P =0.151]. We found that the parameters of hyperlipidemia were not associated with the risk of 28-day all-cause mortality [adjusted HR, 1.23 (95% CI, 0.98-1.55), P = 0.075 in TG increase group; 0.78 (95% CI, 0.57-1.07), P = 0.123 in LDL-C increase group; and 1.12 (95% CI, 0.9-1.39), P = 0.299 in HDL-C decrease group, respectively]. Hyperlipidemia was also not significantly associated with the increased mortality of COVID-19 in patients accompanied with CVDs or type 2 diabetes, and in both male and female cohorts.

Conclusion Our study support that the imbalanced lipid profile is not significantly associated with the 28-day all-cause mortality of COVID-19 patients, even in those accompanied with CVDs or diabetes. Similar results were also obtained in subgroup analyses of abnormal lipid parameters. Therefore, hyperlipidemia might be not a major causative factor for poor outcome of COVID-19, which provides guidance for the intervention of inpatients during the epidemic of COVID-19.

Key words: coronavirus disease 2019 (COVID-19), lipid disorder, mortality, cardiovascular diseases, diabetes

Funding: This work was supported by grants from National Key R&D Program of China(2016YFF0101500);the National Natural Science Foundation of China(81970364);the National Natural Science Foundation of China(81770053)

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