Background: Recently, dyslipidemia was observed in the patients of coronavirus disease 2019 (COVID-19), especially in the severe cases. This study aimed to explore the predictive value of blood lipid for the severity of COVID-19.Methods: All patients with COVID-19 who admitted to HwaMei Hospital, University of Chinese Academy of Sciences from January 23 to April 20, 2020 were included in this retrospective study. General clinical characteristics and laboratory data (including blood lipid parameters) were obtained, and their predictive values for the severity were analyzed.Results: 142 consecutive patients with COVID-19 were included. There were 125 cases in the non-severe group and 17 cases in the severe group. Total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA1) at baseline were significantly lower in the severe group. ApoA1 and interleukin-6 (IL-6) were recognized as independent risk factors for the severity of COVID-19. ApoA1 had the highest area under the receiver operator characteristic curve (AUROC) among all the single markers (AUROC: 0.896, 95% CI: 0.834-0.941). Moreover, the risk model established upon ApoA1 and IL-6 enhanced the predictability (AUROC: 0.977, 95% CI: 0.932-0.995). On the other hand, ApoA1 in the severe group elevated during the treatment, there was no significant difference between the severe and non-severe groups in the recovery stage of disease.Conclusion: The profile of blood lipid in the severe patients with COVID-19 is quite different from that in the non-severe cases. Serum ApoA1 could severe as a good marker to reflect the severity of COVID-19.