Coronavirus disease 2019 (COVID-19) has become a global public health crisis. Reduced
low-density lipoprotein cholesterol (
LDL-C) levels were observed in
COVID-19 patients. The present study aimed to explore the relationship between
LDL-C levels and the prognosis of severe and critical
COVID-19 patients. A total of 211 severe and critical
COVID-19 patients were enrolled and divided into four groups according to the
LDL-C levels, including 53 patients in Group A (
LDL-C ≥ 2.71 mmol/L), 53 patients in Group B (2.28 ≤
LDL-C < 2.71 mmol/L), 53 patients in Group C (1.83 ≤
LDL-C < 2.28 mmol/L) and 52 patients in Group D (
LDL-C < 1.83 mmol/L).
LDL-C levels were lower in
critically ill patients than in severe patients. The main symptoms before admission, characteristics on admission and comorbidities of enrolled patients did not differ among the four groups. Compared with patients with high
LDL-C levels, patients with low
LDL-C levels were more likely to have immune and
inflammation dysfunction, renal
dysfunction, liver dysfunction and cardiac dysfunction on admission. The proportions of patients with
shock and acute cardiac injury, of those admitted to intensive care unit (ICU) and of those treated with
mechanical ventilation were inversely related to
LDL-C level. The mortality of
COVID-19 patients increased with
LDL-C reduction. Serum
LDL-C levels of
COVID-19 patients was negatively correlated with CRP level, but positively correlated with lymphocyte count, as shown by Pearson correlation analysis. Proportional hazard models showed that low
LDL-C levels were associated with increased risk of hospitalization
death, cardiac injury and admission to the ICU. Taken together, these results suggest that decreased
LDL-C levels indicate poor prognosis of severe and critical
COVID-19 patients.