COVID-19 is a worldwide threat to humanity and spread fast. There is no effective vaccine yet, the combined antiviral therapies are performed and have a higher success rate. But we need additional treatments and approaches to this disease.1

I and my colleague realized that the levels of high-density lipoprotein (HDL) and non-HDL were very important for sepsis fatality in a small observational study. We tried to predict mortality with lipoprotein levels and ratios. We have believed that there is a balance between HDL and non-HDL, and it is an immunological actor for infectious disease.2 Our study was about bacterial infections, but a similar relationship may exist in viral infections. Hepatitis-C infections may alter lipoprotein metabolism. Statins have used for adjuvant treatment for chronic hepatitis-C infections.3 HDL may be an innate immunity actor, modulate macrophage functions and inhibit thrombotic events. LDL decrease was shown with inflammation.4

A meta-analysis showed that total cholesterol and low-density lipoprotein (LDL) levels were good predictors for Dengue virus severity. The investigators thought the lipoprotein levels should be screened routinely and the approach should be reconsidered with these levels.5

Another study showed that statin users with Influenza had fewer complications and 30-day mortality than non-users. But this protective association was demonstrated for some seasons and subtypes.6

The lipoprotein levels and ratios may be explored in COVID-19 screening and follow-up may be a predictor for prognosis. These levels and ratios may be targets for treatment.

References

1. Yan Y, Shin WI, Pang YX et al. The First 75 Days of Novel Coronavirus (SARS-CoV-2) Outbreak: Recent Advances, Prevention, and Treatment. Int J Environ Res Public Health. 2020 Mar 30;17(7). pii: E2323. doi: 10.3390/ijerph17072323.

2. Karahan I, Cifci A. Are Lipoprotein Levels and Ratios Able to Predict Mortality due to Sepsis? J Coll Physicians Surg Pak. 2020;30:272-275. doi: 10.29271/jcpsp.2020.03.272.

3. Aizawa Y, Seki N, Nagano T, Abe H. Chronic hepatitis C virus infection and lipoprotein metabolism. World J Gastroenterol. 2015;21:10299-313. doi: 10.3748/wjg.v21.i36.10299.

4. Levine DM, Parker TS, Donnelly TM, Walsh A, Rubin AL. In vivo protection against endotoxin by plasma high density lipoprotein. Proc Natl Acad Sci USA 1993; 90:12040-4.

5. Lima WG, Souza NA, Fernandes SOA, Cardoso VN, Godói IP. Serum lipid profile as a predictor of dengue severity: A systematic review and meta-analysis.

Rev Med Virol. 2019;29:e2056. doi: 10.1002/rmv.2056. Epub 2019 Jun 6.

6. Atamna A, Babitch T, Bracha M Statins and outcomes of hospitalized patients with laboratory-confirmed 2017-2018 influenza. Eur J Clin Microbiol Infect Dis. 2019;38:2341-2348. doi: 10.1007/s10096-019-03684-y.