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      Low HDL-c levels at admission are associated with greater severity and worse clinical outcomes in patients with COVID-19 disease

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          Abstract

          Background and aims

          HDL particles may act to buffer host cells from excessive inflammatory mediators. The aim of this study is to investigate if the lipid profile provides a prognostic biomarker for COVID-19 outcomes.

          Methods

          This was a prospective study of the characteristics of 125 adult COVID-19 patients with a lipid profile performed on the day of admission analyzed with regard to clinical outcomes.

          Results

          Seventy-seven patients (61.2%) were men, with a mean age of 66.3 (15.6) years. 54.1% had bilateral pneumonia. The all-cause mortality rate during hospitalization was 20.8%. We found a direct association between more severe disease assessed by the WHO classification, admission to the ICU and death with more pronounced lymphopenia, higher levels of CRP, ferritin ( p < 0.001), D-dímer and lactate dehydrogenase (LDH) all statistically significant. Lower leves of HDL-c and LDL-c were also associated with a worse WHO classification, ICU admission, and death,. HDL-c levels were inversely correlated with inflammatory markers CRP ( r = −0.333; p < 0.001), ferritin ( r = −0.354; p < 0.001), D-dímer ( r = −0.214; p < 0.001), LDH ( r = −0.209; p < 0.001. LDL-c levels were significantly associated with CRP ( r = −0.320; p < 0.001) and LDH ( r = −0.269; p < 0.001). ROC curves showed that HDL [AUC = 0.737(0.586–0.887), p = 0.005] and lymphocytes [AUC = 0.672(0.497–0.847], p < 0.043] had the best prognostic accuracy to predict death. In a multivariate analysis, HDL-c (β = −0.146(0.770–0.971), p = 0.014) and urea (β = 0.029(1.003–1.057), p = 0.027) predicted mortality.

          Conclusion

          Hypolipidemia including HDL levels at admission identifies patients with a higher risk of death and worse clinical manifestations who may require more intensive care.

          Highlights

          • 125 patients with a lipid profile at admission were included from the first wave of COVID disease.

          • Need of ICU admission and mortality was associated to lower levels of HDL-c and LDL-c.

          • HDL-c levels were inversely correlated with the inflammatory markers associated with the “cytokine storm”.

          • HDL-c at admission identifes patients with a higher risk of death and a worse prognostic course.

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          Most cited references37

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          A Novel Coronavirus from Patients with Pneumonia in China, 2019

          Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
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            Cytokine storm and leukocyte changes in mild versus severe SARS‐CoV‐2 infection: Review of 3939 COVID‐19 patients in China and emerging pathogenesis and therapy concepts

            Abstract Clinical evidence indicates that the fatal outcome observed with severe acute respiratory syndrome‐coronavirus‐2 infection often results from alveolar injury that impedes airway capacity and multi‐organ failure—both of which are associated with the hyperproduction of cytokines, also known as a cytokine storm or cytokine release syndrome. Clinical reports show that both mild and severe forms of disease result in changes in circulating leukocyte subsets and cytokine secretion, particularly IL‐6, IL‐1β, IL‐10, TNF, GM‐CSF, IP‐10 (IFN‐induced protein 10), IL‐17, MCP‐3, and IL‐1ra. Not surprising, therapies that target the immune response and curtail the cytokine storm in coronavirus 2019 (COVID‐19) patients have become a focus of recent clinical trials. Here we review reports on leukocyte and cytokine data associated with COVID‐19 disease in 3939 patients in China and describe emerging data on immunopathology. With an emphasis on immune modulation, we also look at ongoing clinical studies aimed at blocking proinflammatory cytokines; transfer of immunosuppressive mesenchymal stem cells; use of convalescent plasma transfusion; as well as immunoregulatory therapy and traditional Chinese medicine regimes. In examining leukocyte and cytokine activity in COVID‐19, we focus in particular on how these levels are altered as the disease progresses (neutrophil NETosis, macrophage, T cell response, etc.) and proposed consequences to organ pathology (coagulopathy, etc.). Viral and host interactions are described to gain further insight into leukocyte biology and how dysregulated cytokine responses lead to disease and/or organ damage. By better understanding the mechanisms that drive the intensity of a cytokine storm, we can tailor treatment strategies at specific disease stages and improve our response to this worldwide public health threat.
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              Biomarkers associated with COVID-19 disease progression

              Abstract The coronavirus disease 2019 (COVID-19) pandemic is a scientific, medical, and social challenge. The complexity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is centered on the unpredictable clinical course of the disease that can rapidly develop, causing severe and deadly complications. The identification of effective laboratory biomarkers able to classify patients based on their risk is imperative in being able to guarantee prompt treatment. The analysis of recently published studies highlights the role of systemic vasculitis and cytokine mediated coagulation disorders as the principal actors of multi organ failure in patients with severe COVID-19 complications. The following biomarkers have been identified: hematological (lymphocyte count, neutrophil count, neutrophil–lymphocyte ratio (NLR)), inflammatory (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT)), immunological (interleukin (IL)-6 and biochemical (D-dimer, troponin, creatine kinase (CK), aspartate aminotransferase (AST)), especially those related to coagulation cascades in disseminated intravascular coagulation (DIC) and acute respiratory distress syndrome (ARDS). New laboratory biomarkers could be identified through the accurate analysis of multicentric case series; in particular, homocysteine and angiotensin II could play a significant role.

                Author and article information

                Contributors
                Journal
                Atheroscler Plus
                Atheroscler Plus
                Atherosclerosis Plus
                Elsevier
                2667-0909
                2667-0895
                06 March 2023
                June 2023
                06 March 2023
                : 52
                : 1-8
                Affiliations
                [a ]Internal Medicine Department, “Sant Joan” University Hospital (Reus-Spain), Institut Investigació Sanitaria Pere Virgili (IISPV), Universitat Rovira I Virgili, Reus, Spain
                [b ]Internal Medicine Department, Hospital Quiron Salud, Barcelona, Spain
                [c ]BioAegis Therapeutics, North Brunswik, New Jersey, USA
                Author notes
                []Corresponding author. Internal Medicine, Hospital Universitari Sant Joan de Reus, Av/ Josep Laporte, 1, 43206, Reus, Spain. sandra.parra@ 123456urv.cat
                Article
                S2667-0895(23)00002-0
                10.1016/j.athplu.2023.01.002
                9988188
                36910513
                9bac10d6-aee1-43c7-a359-6d102346ddf2
                © 2023 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 28 July 2022
                : 2 January 2023
                : 23 January 2023
                Categories
                Full Length Article

                covid-19,hdl,ldl,biommarker,inflammation,hdl-c, high density cholesterol,ldl-c, low density cholesterol,covid-19, sars-cov2 disesae

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