Association between Lipid Levels, Anti-SARS-CoV-2 Spike Antibodies and COVID-19 Mortality: A Prospective Cohort Study

Sylvia Mink; Christoph H Saely; Matthias Frick; Andreas Leiherer; Heinz Drexel; Peter Fraunberger

doi:10.3390/jcm12155068

Association between Lipid Levels, Anti-SARS-CoV-2 Spike Antibodies and COVID-19 Mortality: A Prospective Cohort Study

J Clin Med. 2023 Aug 1;12(15):5068. doi: 10.3390/jcm12155068.

Authors

Sylvia Mink^{1

2}, Christoph H Saely^{2

3}, Matthias Frick⁴, Andreas Leiherer^{1

2

3}, Heinz Drexel^{2

3

5}, Peter Fraunberger^{1

2}

Affiliations

¹ Central Medical Laboratories, 6800 Feldkirch, Austria.
² Medical-Scientific Faculty, Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein.
³ VIVIT Institute, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria.
⁴ Department of Internal Medicine, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria.
⁵ Drexel University College of Medicine, Philadelphia, PA 19129, USA.

Abstract

Background: Recent studies suggest that both lipid levels and anti-severe-acute-respiratory-syndrome-coronavirus-2 (SARS-CoV-2) antibody levels are associated with outcome in coronavirus disease 2019 (COVID-19). While both parameters have separately been implicated in the neutralization and clearance of pathogens during severe infections, it is currently unclear whether the interplay of these parameters affects outcome in COVID-19. We therefore aimed to determine whether there was a relationship between lipoproteins, anti-SARS-CoV-2 antibodies, and COVID-19 mortality.

Methods: In this prospective, multicenter cohort study, we recruited 1152 hospitalized patients with COVID-19 from five hospitals. Total cholesterol (TC), LDL-C, HDL-C, triglycerides, and anti-SARS-CoV-2 spike antibodies were measured on hospital admission. The investigated endpoint was in-hospital mortality.

Results: LDL-C, HDL-C, and TC were significantly lower in non-survivors than in survivors (mg/dL, 95%CI; 56.1, 50.4-61.8 vs. 72.6, 70.2-75.0, p < 0.001; 34.2, 31.7-36.8 vs. 38.1, 37.2-39.1, p = 0.025; 139.3, 130.9-147.7 vs. 157.4, 54.1-160.6, p = 0.002). Mortality risk increased progressively with lower levels of LDL-C, HDL-C, and TC (aOR 1.73, 1.30-2.31, p < 0.001; 1.44, 1.10-1.88, p = 0.008; 1.49, 1.14-1.94, p < 0.001). Mortality rates varied between 2.1% for high levels of both LDL-C and anti-SARS-CoV-2 antibodies and 16.3% for low levels of LDL-C and anti-SARS-CoV-2 antibodies (aOR 9.14, 95%CI 3.17-26.34, p < 0.001). Accordingly, for total cholesterol and anti-SARS-CoV-2 antibodies, mortality rates varied between 2.1% and 15.0% (aOR 8.01, 95%CI 2.77-23.18, p < 0.001).

Conclusion: The combination of serum lipid levels and anti-SARS-CoV-2 antibodies is strongly associated with in-hospital mortality of patients with COVID-19. Patients with low levels of LDL-C and total cholesterol combined with low levels of anti-SARS-CoV-2 antibodies exhibited the highest mortality rates.

Keywords: COVID-19; HDL-C; LDL-C; SARS-CoV-2; anti-SARS-CoV-2 antibodies; in-hospital mortality; lipid profile; total cholesterol; triglycerides.

Grants and funding

This research received no external funding.