Ventilator-associated pneumonia (VAP) is frequent during severe COVID-19 infection, but diagnosis remains difficult. During bacterial sepsis and COVID-19, high-density lipoprotein cholesterol (HDL-C) concentration is decreased. Furthermore, HDL particles exerting in normal conditions endothelial-protective effects are dysfunctional in bacterial sepsis. The lipidic profile in COVID-19 with associated bacterial infections is unexplored. The aim of the present study was to determine the relationship between HDL-C concentration on admission to the intensive care unit (ICU) for COVID-19 and the occurrence of VAP.

French prospective study (LIPICOR study) recording HDL-C concentration during severe COVID-19 in ICU. VAP episodes were reported prospectively.

122 patients were consecutively included in the analysis between October 2020 and May 2021. A total of 32 patients (26%) developed at least one VAP episode during the ICU stay. The median delay of VAP occurrence was 7 [3,10] days. Upon ICU admission, the median HDL-C concentration was 0.80 [0.65, 1.03] mmol/L. HDL-C was significantly higher in patients who secondarily developed VAP (HDL-C: 0.93 mmol/L [0.79, 1.12] vs. 0.77 mmol/L [0.63, 0.99], p =  0.003). Surprisingly, multivariable analyses with VAP showed that HDL-C at admission is associated with the occurrence of VAP (HR = 3.91 (1.45–10.5), p =  0.007). VAP occurrence in patients with HDL-C levels above 0.8 mmol/L at admission was higher (log-rank test, p =  0.003).

Increased HDL-C concentration on admission is strongly associated with the occurrence of VAP during severe COVID-19 infection.

ClinicalTrials.gov Identifier: NCT05113836.