High Triglycerides Independently Linked with Severe COVID-19 Death

Researchers uncovered that elevated triglyceride levels were linked with COVID-19 death, even after researchers accounted for dexamethasone and propofol sedation commonly used to raise triglycerides themselves, according to a study in the Journal of Clinical Lipidology.¹

“Although COVID-19 is not the same life-threatening pandemic as before, the disease still contains many details that need further investigation,” wrote authors of the study. “Even if the causative agent is an RNA virus, the clinical condition contains many features that are also found in serious bacterial infections.”

In the prospective observational study of 191 hospitalized adults at Karolinska University Hospital, 77% of patients fulfilled Sepsis-3 criteria, establishing severe COVID-19 as a homogeneous clinical model for viral sepsis. Non-survivors presented with significantly higher median serum triglyceride levels of 3.2 mmol/L compared with 2.1 mmol/L among survivors.¹

READ MORE: No Added Adverse Event Risk in Pfizer-BioNTech COVID-19 Vaccine

Elevated triglycerides were the single strongest independent laboratory predictor of mortality, yielding a hazard ratio of 1.18 per 1 mmol/L increase even after adjusting for cumulative corticosteroid exposure, propofol sedation, body mass index, and acute inflammatory markers.

“Retrospective studies have produced conflicting results on the protective effect of the prior use of statins,” said Dale Nyholt, PhD, professor at the Queensland University of Technology, according to a release.² “This could be partially explained by the presence of other medical conditions in statin users. Therefore, our results provide important clarity and support targeted reduction of triglycerides to help prevent severe COVID-19.”

Pharmacotherapeutic Implications and Clinical Treatment Challenges

Findings from the current study highlight serum triglycerides as an accessible prognostic biomarker for pharmacists evaluating critical care pharmacotherapy and mortality risk profiles in patients with viral sepsis phenotypes.¹

For clinical pharmacists managing intensive care drug therapy, addressing infection-induced dyslipidemia involves navigating complex therapeutic trade-offs. A retrospective cohort study in Qatar examining 1234 critically ill COVID-19 patients found that 82.3% developed hypertriglyceridemia, with specific pharmacological agents serving as key predictors of elevated lipid levels.³

Specifically, treatment with the interleukin-6 receptor antagonist tocilizumab significantly increased the odds of experiencing elevated triglycerides with an odds ratio of 3.508, while also increasing the likelihood of receiving lipid-lowering therapy.

However, inpatient administration of lipid-modulating agents such as fenofibrate or omega-3 fatty acids did not reduce 30-day or 60-day mortality rates, instead reflecting greater underlying illness severity and longer overall hospital stays among treated individuals.³

Synthesizing Evidence Across Lipid Profiles

A major systematic review and meta-analysis of 22 studies encompassing 10,122 hospitalized patients demonstrated that despite total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol significantly reducing in severe cases and among non-survivors, serum triglyceride levels exhibited substantial heterogeneity across diverse patient populations.⁴

Similarly, another meta-analysis of 19 studies comprising 5690 patients confirmed that marked hypolipidemia across standard cholesterol fractions strongly correlates with disease severity and mortality, whereas triglyceride spikes are more variable and distinct to specific viral sepsis cohorts.^1,5

Pharmacists should recognize that although depressed cholesterol levels stem from systemic inflammation, altered vascular permeability, and impaired hepatic synthesis, elevated triglycerides serve as unique indicators of metabolic strain during severe viral infection.^1,3,5

Seasonal Outlook and Broader Relevance for Pharmacy Practice

The ongoing clinical necessity of monitoring viral infection biomarkers is further underscored by seasonal public health surveillance data.⁶

According to the CDC 2026-2027 Respiratory Disease Season Outlook, health systems are projected to experience peak combined hospitalization rates for COVID-19, influenza, and respiratory syncytial virus (RSV) similar to previous seasons. Because respiratory infections continue to drive significant hospital admissions each fall and winter, routine laboratory parameters like standard lipid panels represent cost-effective, readily available tools for patient monitoring.^1,5,6

For pharmacists overseeing critical care protocols and therapeutic drug monitoring, incorporating routine triglyceride measurements offers meaningful prognostic insight during seasonal surges of acute respiratory illness.^1,5

“Taken together, our data suggest that lipid parameters could be an important biochemical marker in severe COVID-19 cases and possibly also in other cases with sepsis, which, however, remains to be tested,” concluded authors of the current study.¹ “Given that lipid analyses are well established, usually quite accessible, and cost-effective, their incorporation into the routine diagnostics of infectious patients will represent a feasible and valuable strategy.”

READ MORE: COVID-19 Resource Center

REFERENCES

1. Eklund DPO, Szili-Török T, Strålin K, et al. Elevated triglycerides predict increased mortality in patients with severe COVID-19 - an observational study. J Clin Lipidol. 2026;20(10):2246-2254. doi:10.1016/j.jacl.2026.08.004

2. Severe COVID-19 risk elevated by high triglyceride level. Queensland University of Technology. News Release. November 30, 2022. Accessed November 10, 2026. https://www.eurekalert.org/news-releases/973006

3. Kaddoura R, Ibrahim MIM, Al-Amri M, et al. COVID-19-associated hypertriglyceridemia and impact of treatment. Front Med (Lausanne). 2024;11:1326156. doi:10.3389/fmed.2024.1326156

4. Zinellu A, Paliogiannis P, Fois AG, et al. Cholesterol and triglyceride concentrations, COVID-19 severity, and mortality: a systematic review and meta-analysis with meta-regression. Front Public Health. 2021;9:705916. doi:10.3389/fpubh.2021.705916

5. Mahat RK, Rathore V, Singh N, et al. Lipid profile as an indicator of COVID-19 severity: a systematic review and meta-analysis. Clin Nutr ESPEN. 2021;45:91-101. doi:10.1016/j.clnesp.2021.07.023

6. 2026-2027 respiratory disease season Outlook. CDC. November 10, 2026. Accessed November 10, 2026. https://www.cdc.gov/cfa-qualitative-assessments/php/data-research/season-outlook26-27.html