Effect of COVID-19 on Lipid Profile and its Correlation with Acute Phase Reactants

  1. Jahanzeb Malik
  2. Talha Laique
  3. Uzma Ishaq
  4. Amna Ashraf
  5. Asmara Malik
  6. Mommana Ali
  7. Syed Muhammad Jawad Zaidi
  8. Muhammad Javaid
  9. Asad Mehmood

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Abstract

Background and Objective

Coronavirus disease 2019 (COVID-19) manifests as multiple clinical and pathological organ dysfunctions. It also disrupts metabolic profile due to the release of pro-inflammatory cytokines causing a systemic inflammation reaction. However, the development and correlation of dyslipidemia with acute phase reactants is unknown. This investigation was performed to assess the pathological alterations of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein (HDL), triglycerides, and total cholesterol levels in COVID-19 patients.

Methods

This was a prospective study performed on real-world patients to assess serum levels of LDL-C, HDL, TG, TC on COVID-19 patients (mild: 319; moderate: 391; critical: 357) hospitalized at our center between April 2020 through January 2021. Age- and gender-matched controls who had their lipid profiles in the same period were included as the control group.

Results

LDL-C, HDL, TG, and TC levels were significantly lower in COVID-19 patients when compared with the control group (P < 0.001, 0.047, 0.045, < 0.001, respectively). All parameters decreased gradually with COVID-19 disease severity (LDL-C: median (IQR), mild: 98 (91,134); moderate: 97 (81,113); critical: 68 (68,83); HDL: mild: 45 (37,50); moderate: 46 (41,50); critical: 40 (37,46); TG: mild: 186 (150,245); moderate: 156 (109,198); critical: 111 (98,154); TC: mild: 224 (212,238); moderate: 212 (203,213); critical: 154 (125,187)). LDL-C, TC, and TG were inversely correlated with acute phase reactants (interleukin-6 (IL-6), Procalcitonin, C-reactive protein (CRP), and D-dimers). Logistic regression demonstrated lipid profile, thyroid profile, and acute phase reactants as predictors of severity of COVID-19 disease.

Conclusion

Hypolipidemia develops in increasing frequency with severe COVID-19 disease. It inversely correlates with levels of acute-phase reactants, indicating SARS-COV-2 as the causative agent for alteration in lipid and thyroid levels.

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  1. ScreenIT

    SciScore for 10.1101/2021.04.13.21255142: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Study design and patient demographics: This prospective study was carried out at Infectious Disease Block, Advanced Diagnostics and Liver Center, Rawalpindi, and was approved by the Review Committee (Study ID#ADC/20/006) of Advanced Diagnostics and Liver Center according to the ethical principles of the Declaration of Helsinki.
    Consent: Written, informed consent was taken from all the participants/guardians before data collection.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Laboratory tests: All the laboratory tests were carries out at our certified laboratory in Advance Diagnostics under the standard procedures of the Punjab Healthcare Commission
    Punjab Healthcare
    suggested: None
    Statistical analysis: Data were analyzed with Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corp, Armonk, NY, USA.)
    Statistical Package for the Social Sciences
    suggested: (SPSS, RRID:SCR_002865)
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There were several limitations of this investigation. First, the time of symptom onset to the time of sample collection was variable in this cohort. Therefore, the analysis might represent heterogeneous results of the COVID-19 disease course. Second, many patients were already on statin treatment and the level of precise alteration in lipid profile during the disease course of the COVID-19 cohort could be biased towards depressed lipid levels in these patients. Third, the control group patients were healthy individuals with no severe or critical form of acute illness. This could have produced a sample selection bias, producing abnormal results in this investigation. Fourth, no follow-up data of the lipid profile and its alteration was collected for monitoring the dynamics of COVID-19. This will be needed for better characterization of this phenomenon in the COVID-19 cohort.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.04.13.21255142v1 on medRxiv