For patients hospitalized with COVID-19, the presence of metabolic syndrome is associated with increased odds of acute respiratory distress syndrome (ARDS) and mortality, according to a study published in JAMA Network Open .
Key points Ask What is the risk of acute respiratory distress syndrome (ARDS) and death in COVID-19 patients with metabolic syndrome? Findings In this cohort study that included 46,441 patients hospitalized with COVID-19, metabolic syndrome was associated with a significantly increased odds of ARDS and death. With each metabolic syndrome criterion added from 1 to 4 criteria, the risk of ARDS increased significantly in an additive manner. Meaning These findings suggest that metabolic syndrome and its associated comorbidities were critical risk factors associated with COVID-19-related ARDS and death. |
Importance
Obesity, diabetes, and hypertension are common comorbidities in patients with severe COVID-19, although little is known about the risk of acute respiratory distress syndrome (ARDS) or death in patients with COVID-19 and metabolic syndrome.
Aim
To determine whether metabolic syndrome is associated with an increased risk of ARDS and death from COVID-19.
Design, environment and participants
This multicenter cohort study used data from the Society of Critical Care Medicine’s Discovery Viral Respiratory Illness universal study collected from 181 hospitals in 26 countries from February 15, 2020 to February 18, 2021.
Results were compared between patients with metabolic syndrome (defined as ≥3 of the following criteria: obesity, prediabetes or diabetes, hypertension, and dyslipidemia) and a control population without metabolic syndrome.
Participants included adult patients hospitalized for COVID-19 during the study period who had a complete discharge status. Data was analyzed from February 22 to October 5, 2021.
Exhibitions
Exposures were SARS-CoV-2 infection, metabolic syndrome, obesity, prediabetes or diabetes, hypertension, and/or dyslipidemia.
Main results and measures
The main outcome was in-hospital mortality. Secondary outcomes included ARDS, intensive care unit (ICU) admission, need for invasive mechanical ventilation, and length of stay (LOS).
Results
Among 46,441 patients hospitalized with COVID-19, 29,040 patients (mean [SD] age, 61.2 [17.8] years; 13,059 [45.0%] women and 15,713 [54.1%] men; 6,797 Black patients [23.4%], 5325 Hispanic patients [18.3%] and 16 507 white patients [57.8%]) met the inclusion criteria.
A total of 5,069 patients (17.5%) with metabolic syndrome were compared with 23,971 control patients (82.5%) without metabolic syndrome.
In adjusted analyses, metabolic syndrome was associated with an increased risk of ICU admission (adjusted odds ratio [aOR], 1.32 [95% CI, 1.14-1.53]), invasive mechanical ventilation (aOR), , 1.45 [95% CI, 1.28-1.65]), ARDS (aOR, 1.36 [95% CI, 1.12-1.66]), and mortality (aOR, 1.19 [95% CI, 1.08-1.31]) and prolonged hospital stays (median [IQR], 8.0 [4.2-15.8] days vs. 6.8 [3.4-13. 0] days; P < 0.001) and ICU LOS (median [IQR], 7.0 [2.8-15.0] days vs. 6.4 [2.7-13.0] days; P < 0.001).
Each additional metabolic syndrome criterion was associated with an increased risk of ARDS in an additive manner (1 criterion: 1147 ARDS patients [10.4%]; p = 0.83; 2 criteria: 1191 ARDS patients [15.3%] ]; p <0.001; 3 criteria: 817 patients with ARDS [19.3%]; p <0.001; 4 criteria: 203 patients with ARDS [24.3%]; p <0.001).
Additive associations of individual metabolic syndrome criteria with outcomes
Conclusions and relevance These findings suggest that metabolic syndrome was associated with an increased risk of ARDS and death in patients hospitalized with COVID-19. The association with ARDS was cumulative for each metabolic syndrome criterion present. |
Comments
Joshua L. Denson, MD, of Tulane University School of Medicine in New Orleans, and colleagues conducted a multicenter cohort study to examine whether metabolic syndrome is associated with an increased risk of ARDS and death from COVID -19.
Outcomes were compared for hospitalized COVID-19 patients with metabolic syndrome (three or more of the following: obesity, prediabetes or diabetes, hypertension, dyslipidemia; 5,069 adults) and controls without metabolic syndrome (23,971 adults).
The researchers found that metabolic syndrome was associated with an increased risk of intensive care unit (ICU) admission, invasive mechanical ventilation, ARDS, and mortality (adjusted odds ratios, 1.32, 1.45, 1.36, and 1.19, respectively) and with hospitalization and ICU length of stay (median, 8.0 vs. 6.8 days and 7.0 vs. 6.4 days, respectively).
The risk of ARDS increased additively with each additional criterion of metabolic syndrome (one criterion: 10.4 percent; two criteria: 15.3 percent; three criteria: 19.3 percent; four criteria: 24.3 percent hundred).
"Given the high rates of metabolic syndrome, obesity, and diabetes in the United States, one hypothesis for why the United States led the world in COVID-19 cases and deaths could be the high prevalence of metabolic syndrome in this population," the researchers state. authors.
