Background: Emerging studies have described and analyzed epidemiological, clinical, laboratory, and radiological features of
COVID-19 patients. Yet, scarce information is available regarding the association of
lipid profile features and disease severity and mortality. Methods: We conducted a prospective observational cohort study to investigate
lipid profile features in patients with
COVID-19. From 9 February to 4 April 2020, a total of 99 patients (31
critically ill and 20 severely ill) with confirmed
COVID-19 were included in the study. Dynamic alterations in
lipid profiles were recorded and tracked. Outcomes were followed up until 4 April 2020. Results: We found that
high-density lipoprotein-cholesterol (HDL-C) and
apolipoprotein A-1 (apoA-1) levels were significantly lower in the severe disease group, with mortality cases showing the lowest levels (p < 0.0001). Furthermore, HDL-C and
apoA-1 levels were independently associated with disease severity (
apoA-1: odds ratio (OR): 0.651, 95% confidence interval (CI): 0.456-0.929, p = 0.018; HDL-C: OR: 0.643, 95% CI: 0.456-0.906, p = 0.012). For predicting disease severity, the areas under the receiver operating characteristic curves (AUCs) of HDL-C and
apoA-1 levels at admission were 0.78 (95% CI, 0.70-0.85) and 0.85 (95% CI, 0.76-0.91), respectively. For in-hospital deaths, HDL-C and
apoA-1 levels demonstrated similar discrimination ability, with AUCs of 0.75 (95% CI, 0.61-0.88) and 0.74 (95% CI, 0.61-0.88), respectively. Moreover, patients with lower serum concentrations of
apoA-1 (<0.95 g/L) or HDL-C (<0.84 mmol/l) had higher mortality rates during hospitalization (log-rank p < 0.001). Notably, levels of
apoA-1 and HDL-C were inversely proportional to disease severity. The survivors of severe cases showed significant recovery of
apoA-1 levels at the end of hospitalization (vs. midterm
apoA-1 levels, p = 0.02), whereas the mortality cases demonstrated continuously lower
apoA-1 levels throughout hospitalization. Correlation analysis revealed that
apoA-1 and HDL-C levels were negatively correlated with both admission levels and highest concentrations of
C-reactive protein and
interleukin-6. Conclusions: Severely ill
COVID-19 patients featured low HDL-C and
apoA-1 levels, which were strongly correlated with inflammatory states. Thus, low
apoA-1 and HDL-C levels may be promising predictors for severe disease and in-hospital mortality in patients suffering from
COVID-19.