MO825: Low High-Density Lipoprotein Level Predicts Covid-19 Severity and Mortality in Haemodialysis Patients
Authors: Stepanova Natalia , Rysyev Andriy , Rusyn Oksana , Ostapenko Tetyana , Snisar Lyudmyla , Pyankovskyi Serhiy , Kompaniets Olga 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Several recent studies have demonstrated the association between low high-density lipoprotein cholesterol (HDL-C) levels and poor outcomes in COVID-19-infected patients. However, there is a general lack of research in this field in the haemodialysis population. Therefore, in the present study, we retrospectively examined the association between HDL-C levels and the risk of developing severe outcomes of COVID-19 infection in haemodialysis (HD) patients.

METHOD
A total of 428 HD patients aged 55 (44–64) years and a dialysis vintage of 44 (21–76.6) months were enrolled in this multicentre retrospective cohort study between March 2020 and September 2021. Baseline HDL-C levels were obtained from electronic health records of the patients in the dialysis centres. (The last measurements were carried out before the COVID-19 onset.) Severe COVID-19-associated pneumonia was estimated based on chest computed tomography (CT) findings of pulmonary involvement and assessed using the following scoring system: (1) indicating &lt;5% involvement, (2) indicating 5%–25% involvement, (3) indicating 26%–49% involvement, (4) indicating 50%–75% involvement and (5) indicating more &gt;75% involvement. The primary and the secondary endpoints were COVID-19-related hospitalization and death, respectively.
The data were presented as the median and the interquartile ranges [Me (Q25–Q75)] and compared using the Kruskal–Wallis test. The Spearmen correlation test was used to assess the association between HDL-C and other markers. The multivariate logistic regression and the receiver operating characteristic (ROC) analyses were performed to evaluate the ability of HDL-C for predicting the severity of COVID-19 infection.

RESULTS
Among 428 enrolled patients, there were 142 (33.2%) patients infected with COVID-19 and 286 (66.8%) patients who had a negative result in COVID-19 PCR tests. A total of 108 (76%) patients of 142 COVID-19 positive patients did not require any oxygen support; 40 patients (28%) were hospitalized, 34 patients (24%) needed oxygen supplements and 16 patients (11.3%) died. The chest CT findings were scored from 2 to 4 in almost all HD patients (99.3%), and only 2 patients had 75% pulmonary involvement. The baseline HDL-C level was significantly lower in the patients with severe COVID-19-associated pneumonia compared with the patients with mild and moderate pneumonia scores (Fig. 1). Moreover, HDL-C was negatively correlated with serum C-reactive protein (CRP) (r = –0.42; P = 0.0002) and D-dimer (r = –0.31; P = 0.001) levels.
In the multivariate logistic regression analysis adjusted for age, diabetes, CRP and D-dimer, HDL-C was found to be associated with COVID-19-related hospitalization {OR: 2.4, [95% confidence interval (95% CI) 1.19–4.7]; P = 0.001} and deaths (OR: 3.1, 95% CI 1.28–5.6; P = 0.008) in the HD patients. The ROC curve analysis demonstrated that the most appropriate cut-off point for baseline HDL-C level for predicting severe COVID-19 prognosis in the HD patients was ≤1.2 2 mmol/L with a sensitivity of 93.7% and a specificity of 63.2%. The area under the ROC curve was 0.83 (95% CI 0.76–0.89; P &lt; 0.0001).

CONCLUSION
HDL-C level ≤1.22 mmol/L was independently associated with a severe COVID-19 prognosis in the cohort of our HD patients. Further research with a greater cohort is needed to confirm this preliminary evidence and validate HDL-C level as a predictive biomarker for COVID-19 severity and mortality in HD patients.