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Cholesterol and Triglyceride Concentrations, COVID-19 Severity, and Mortality: A Systematic Review and Meta-Analysis With Meta-Regression

Lipid profile alterations have been observed in patients with coronavirus disease 2019 (COVID-19) in relation to disease severity and mortality. We conducted a systematic review and meta-analysis with meta-regression of studies reporting total, HDL, and LDL-cholesterol, and triglyceride concentratio...

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Autores principales: Zinellu, Angelo, Paliogiannis, Panagiotis, Fois, Alessandro G., Solidoro, Paolo, Carru, Ciriaco, Mangoni, Arduino A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8417431/
https://www.ncbi.nlm.nih.gov/pubmed/34490188
http://dx.doi.org/10.3389/fpubh.2021.705916
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author Zinellu, Angelo
Paliogiannis, Panagiotis
Fois, Alessandro G.
Solidoro, Paolo
Carru, Ciriaco
Mangoni, Arduino A.
author_facet Zinellu, Angelo
Paliogiannis, Panagiotis
Fois, Alessandro G.
Solidoro, Paolo
Carru, Ciriaco
Mangoni, Arduino A.
author_sort Zinellu, Angelo
collection PubMed
description Lipid profile alterations have been observed in patients with coronavirus disease 2019 (COVID-19) in relation to disease severity and mortality. We conducted a systematic review and meta-analysis with meta-regression of studies reporting total, HDL, and LDL-cholesterol, and triglyceride concentrations in hospitalized patients with COVID-19. We searched PubMed, Web of Science and Scopus, between January 2020 and January 2021, for studies describing lipid concentrations, COVID-19 severity, and survival status (PROSPERO registration number: CRD42021253401). Twenty-two studies in 10,122 COVID-19 patients were included in the meta-analysis. Pooled results showed that hospitalized patients with severe disease or non-survivor status had significantly lower total cholesterol (standardized mean difference, SMD = −0.29, 95% CI −0.41 to −0.16, p < 0.001), LDL-cholesterol (SMD = −0.30, 95% CI −0.41 to −0.18, p < 0.001), and HDL-cholesterol (SMD = −0.44, 95% CI −0.62 to −0.26, p < 0.001), but not triglyceride (SMD = 0.04, 95% CI −0.10 to −0.19, p = 0.57), concentrations compared to patients with milder disease or survivor status during follow up. Between-study heterogeneity was large-to-extreme. In sensitivity analysis, the effect size of different lipid fractions was not affected when each study was in turn removed. The Begg's and Egger's t-tests did not show evidence of publication bias, except for studies investigating LDL-cholesterol. In meta-regression, significant associations were observed between the SMD of LDL-cholesterol and age and hypertension, and between the SMD of triglycerides and study endpoint and aspartate aminotransferase. In our systematic review and meta-analysis, lower total, HDL, and LDL-cholesterol, but not triglyceride, concentrations were significantly associated with COVID-19 severity and mortality. Cholesterol concentrations might be useful, in combination with other clinical and demographic variables, for risk stratification and monitoring in this group. Systematic Review Registration: PROSPERO registration number: CRD42021253401.
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spelling pubmed-84174312021-09-05 Cholesterol and Triglyceride Concentrations, COVID-19 Severity, and Mortality: A Systematic Review and Meta-Analysis With Meta-Regression Zinellu, Angelo Paliogiannis, Panagiotis Fois, Alessandro G. Solidoro, Paolo Carru, Ciriaco Mangoni, Arduino A. Front Public Health Public Health Lipid profile alterations have been observed in patients with coronavirus disease 2019 (COVID-19) in relation to disease severity and mortality. We conducted a systematic review and meta-analysis with meta-regression of studies reporting total, HDL, and LDL-cholesterol, and triglyceride concentrations in hospitalized patients with COVID-19. We searched PubMed, Web of Science and Scopus, between January 2020 and January 2021, for studies describing lipid concentrations, COVID-19 severity, and survival status (PROSPERO registration number: CRD42021253401). Twenty-two studies in 10,122 COVID-19 patients were included in the meta-analysis. Pooled results showed that hospitalized patients with severe disease or non-survivor status had significantly lower total cholesterol (standardized mean difference, SMD = −0.29, 95% CI −0.41 to −0.16, p < 0.001), LDL-cholesterol (SMD = −0.30, 95% CI −0.41 to −0.18, p < 0.001), and HDL-cholesterol (SMD = −0.44, 95% CI −0.62 to −0.26, p < 0.001), but not triglyceride (SMD = 0.04, 95% CI −0.10 to −0.19, p = 0.57), concentrations compared to patients with milder disease or survivor status during follow up. Between-study heterogeneity was large-to-extreme. In sensitivity analysis, the effect size of different lipid fractions was not affected when each study was in turn removed. The Begg's and Egger's t-tests did not show evidence of publication bias, except for studies investigating LDL-cholesterol. In meta-regression, significant associations were observed between the SMD of LDL-cholesterol and age and hypertension, and between the SMD of triglycerides and study endpoint and aspartate aminotransferase. In our systematic review and meta-analysis, lower total, HDL, and LDL-cholesterol, but not triglyceride, concentrations were significantly associated with COVID-19 severity and mortality. Cholesterol concentrations might be useful, in combination with other clinical and demographic variables, for risk stratification and monitoring in this group. Systematic Review Registration: PROSPERO registration number: CRD42021253401. Frontiers Media S.A. 2021-08-18 /pmc/articles/PMC8417431/ /pubmed/34490188 http://dx.doi.org/10.3389/fpubh.2021.705916 Text en Copyright © 2021 Zinellu, Paliogiannis, Fois, Solidoro, Carru and Mangoni. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Zinellu, Angelo
Paliogiannis, Panagiotis
Fois, Alessandro G.
Solidoro, Paolo
Carru, Ciriaco
Mangoni, Arduino A.
Cholesterol and Triglyceride Concentrations, COVID-19 Severity, and Mortality: A Systematic Review and Meta-Analysis With Meta-Regression
title Cholesterol and Triglyceride Concentrations, COVID-19 Severity, and Mortality: A Systematic Review and Meta-Analysis With Meta-Regression
title_full Cholesterol and Triglyceride Concentrations, COVID-19 Severity, and Mortality: A Systematic Review and Meta-Analysis With Meta-Regression
title_fullStr Cholesterol and Triglyceride Concentrations, COVID-19 Severity, and Mortality: A Systematic Review and Meta-Analysis With Meta-Regression
title_full_unstemmed Cholesterol and Triglyceride Concentrations, COVID-19 Severity, and Mortality: A Systematic Review and Meta-Analysis With Meta-Regression
title_short Cholesterol and Triglyceride Concentrations, COVID-19 Severity, and Mortality: A Systematic Review and Meta-Analysis With Meta-Regression
title_sort cholesterol and triglyceride concentrations, covid-19 severity, and mortality: a systematic review and meta-analysis with meta-regression
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8417431/
https://www.ncbi.nlm.nih.gov/pubmed/34490188
http://dx.doi.org/10.3389/fpubh.2021.705916
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