Atherogenic Dyslipidemia on Admission Is Associated With Poorer Outcome in People With and Without Diabetes Hospitalized for COVID-19

Alfonso Bellia, Aikaterini Andreadi, Luca Giudice, Sofia De Taddeo, Alessio Maiorino, Ilenia D'Ippolito, Federica Maria Giorgino, Valeria Ruotolo, Maria Romano, Andrea Magrini, Nicola Di Daniele, Paola Rogliani, Davide Lauro

Diabetes Care 2021 July 12

OBJECTIVE: Identifying metabolic factors associated with critical disease can help to improve management of patients hospitalized for coronavirus disease 2019 (COVID-19). High triglycerides and low HDL levels characterize the atherogenic dyslipidemia closely related to insulin resistance and diabetes. We examined associations of atherogenic dyslipidemia detected on admission with outcome of COVID-19 during hospitalization.

RESEARCH DESIGN AND METHODS: We retrospectively analyzed clinical reports of 118 consecutive patients hospitalized for COVID-19 in Rome, Italy, between March and May 2020. Clinical characteristics, inflammation markers, and glucose and lipid metabolism parameters at admission were collected. Critical disease was defined as in-hospital death or need for endotracheal intubation. Associations were tested using logistic regression analysis.

RESULTS: Patients with critical COVID-19 ( n = 43) were significantly older than those with noncritical disease ( n = 75) and presented higher levels of fasting glucose, triglycerides, C-reactive protein, interleukin-6, procalcitonin, and d-dimer ( P < 0.01 for all), whereas HDL levels were lower ( P = 0.003). Atherogenic dyslipidemia was more frequent in patients with critical COVID-19 (46 vs. 24%, P = 0.011), as well as diabetes (37 vs. 19%, P = 0.026), and significantly associated with death or intubation (odds ratio 2.53 [95% CI 1.16-6.32], P = 0.018). Triglycerides were significantly associated with selected inflammatory biomarkers ( P < 0.05 for all) and poorer outcome of COVID-19 during hospitalization in both the overall population and the subgroup with atherogenic dyslipidemia.

CONCLUSIONS: Atherogenic dyslipidemia detected on admission can be associated with critical in-hospital course of COVID-19. Further investigations are needed to elucidate the hypothetical role of insulin resistance and related lipid abnormalities in severe acute respiratory syndrome coronavirus 2 pathogenesis. Assessment of lipid profile should be encouraged in patients hospitalized for COVID-19.