Association of triglyceride/high-density lipoprotein cholesterol ratio with severe complications of COVID-19

Yoonkyung Chang, Jimin Jeon, Tae Jin Song, Jinkwon Kim

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: The coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus can lead to serious complications such as respiratory failure, requiring mechanical ventilation or ICU care, and can even result in death, especially in older patients with comorbidities. The ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL), a biomarker of atherosclerotic dyslipidemia and insulin resistance, is related to cardiovascular mortality and morbidity. We aimed to evaluate the link between serious complications of COVID-19 and TG/HDL in the general population. Methods: We conducted a comprehensive analysis of 3,933 COVID-19 patients from a nationwide cohort in Korea spanning from January 1 to June 4, 2020. TG/HDL ratio was calculated from the national health screening examination data underwent before the COVID-19 infection. Serious complications of COVID-19 were defined as a composite of high-flow oxygen therapy, mechanical ventilation, admission to the intensive care unit (ICU), and mortality. We employed logistic regression analysis to investigate the relationship between the TG/HDL ratio and the likelihood of developing severe complications within 2 months of the diagnosis. To visualize this association, we used a smoothing spline plot based on the generalized additive regression model. Multivariate analysis was performed with adjustment for age, gender, body mass index, lifestyle measures, and comorbidities. Results: Among the 3,933 COVID-19 patients, the proportion of serious complications was 7.53%. Regarding individual outcomes, the number of patients who received high-flow oxygen therapy, mechanical ventilation, ICU care, and died was 84 (2.14%), 122 (3.10%), 173 (4.40%), and 118 (3.00%), respectively. In the multivariable logistic regression, a positive association was found between TG/HDL ratio and serious complications of COVID-19 (adjusted OR, 1.09; 95% CI [1.03–1.15], p = 0.004). Conclusion: Our study revealed a significant positive association between TG/HDL ratio and the risk of developing severe complications in COVID-19-infected patients. While this finding provides valuable insight into the potential prognostic role of TG/HDL ratio in COVID-19, further studies are needed to fully elucidate the underlying mechanisms behind this relationship.

Original languageEnglish
Article numbere17428
Issue number6
StatePublished - Jun 2023

Bibliographical note

Funding Information:
This project was supported by a grant from the Basic Science Research Program through the National Research Foundation of Korea , funded by the Ministry of Education ( 2021R1F1A1048113 to T-JS, 2021R1I1A1A01059868 to YC, 2020R1I1A1A01060447 to JK), the Institute of Information & Communications Technology Planning & Evaluation (IITP) grant , funded by the Korean Government (MSIT) (No. 2022-0-00621 to T-JS, Development of artificial intelligence technology that provides dialog-based multi-modal explainability), and a new faculty research seed money grant of Yonsei University College of Medicine for 2022 ( 2022-32-0058 to JK). The funding source had no role in the study's design, conduct, or reporting.

Publisher Copyright:
© 2023 The Authors


  • COVID-19
  • Insulin resistance
  • Prognosis
  • TG/HDL ratio


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