Patients hospitalised with COVID-19, who had a combination of high blood pressure, obesity, diabetes, or other conditions associated with metabolic syndrome, were at much higher risk of acute respiratory distress syndrome (ARDS) and death, according to an international study published in the medical journal JAMA Network Open.
The risk of developing ARDS, a life-threatening lung condition that causes low blood oxygen, grew progressively higher with each additional metabolic syndrome criteria present. The study, one of the largest to examine the link between metabolic syndrome and outcomes for COVID- 19, examined records of more than 46,000 patients admitted in 181 hospitals across 26 countries.
“Our study found that if you have high cholesterol, high blood pressure, mild obesity and pre-diabetes or diabetes and are hospitalised with COVID-19, you have a one in four chance of developing ARDS, which is significant,” said lead author of the study Dr Joshua Denson, pulmonary and critical care medicine physician and assistant professor of medicine at Tulane University School of Medicine. “We also found that at every level of respiratory support, patients with metabolic syndrome experienced worse outcomes. Metabolic syndrome patients experienced increased invasive mechanical ventilation, increased non-invasive ventilation, or high-flow oxygen support, and increased supplemental oxygen use compared with patients without metabolic syndrome.”
“These important findings are another example of possibilities from pooled data of hundreds of hospitals in detecting meaningful associations during the pandemic,” said Rahul Kashyap, senior author of the study and principal investigator of the Discovery VIRUS: COVID-19 Registry.
“These findings will assist with efforts for creating national infrastructures, for identifying critical illness risk factors and testing novel/re-purposed medications to help improve patient outcomes.”
Researchers from Tulane University, the Society of Critical Care Medicine and Mayo Clinic followed outcomes for patients hospitalised between mid-February 2020 to mid-February 2021 in the Discovery VIRUS: COVID-19 Registry. They compared 5,069 patients (17.5%) with metabolic syndrome with 23,971 control patients (82.5%) without metabolic syndrome. They defined metabolic syndrome as having more than three of the following criteria: obesity, pre-diabetes or diabetes, hypertension and high cholesterol.
Patients with metabolic syndrome were 36% more likely to develop ARDS, almost 20% more likely to die in the hospital, more than 30% more likely to be admitted to an ICU, and 45% more likely to require mechanical ventilation. Researchers calculated these risks after adjusting for race, age, sex, ethnicity, other comorbid conditions, and hospital case volume.
Overall, slightly more than 20% of the patients with metabolic syndrome died in the hospital, 20% developed ARDS and almost half were admitted to the ICU. Approximately 16% of those without metabolic syndrome died, 12% developed ARDS and nearly 36% were admitted to the ICU.
Metabolic syndrome was significantly more common among patients with COVID-19 admitted to US hospitals (18.8%) than those admitted to non-US hospitals (8%).
According to the US Centers for Disease Control & Prevention, more than a third of adults in the US meet the criteria for metabolic syndrome, with some regions having a metabolic syndrome prevalence greater than 40%.
Severe cases of COVID-19 are characterised by a hyper-inflammatory immune response to the infection throughout the body. Authors suspect that chronic low-grade inflammation from metabolic diseases, mainly when clustered together, could make these patients more vulnerable to COVID-19.
The researchers note that given the high rates of metabolic syndrome, obesity and diabetes in the US, one hypothesis for why the country leads the world in COVID-19 cases and deaths could be the high prevalence of metabolic syndrome in this population.
This study was made possible by the Viral Infection and Respiratory Illness Universal Study (VIRUS) that reveals practice variations and provides a rich database for research into effective treatments and care. The Society of Critical Care Medicine’s Discovery, the Critical Care Research Network and Mayo Clinic launched this first global COVID-19 registry that tracks ICU and hospital care patterns in near real-time in March 2020.
Study details
Metabolic Syndrome and Acute Respiratory Distress Syndrome in Hospitalized Patients With COVID-19.
Joshua Denson, Aaron Gillet, Yuanhao Zu, Margo Brown, Thaidan Pham, Yilin Yoshida, Franck Mauvais-Jarvis, Ivor Douglas, Mathew Moore, Kevin Tea, Andrew Wetherbie, Rachael Stevens, John Lefante, Jeffrey Shaffer, Donna Lee Armaignac, Katherine Belden, Margit Kaufman, Smith Heavner, Valerie Danesh, Sreekanth Cheruku, Catherine St. Hill, Karen Boman, Neha Deo, Vikas Bansal, Vishakha Kumar, Allan Walkey, Rahul Kashyap.
Published in JAMA Network Open on 22 December 2021
Key Points
Question What is the risk of acute respiratory distress syndrome (ARDS) and death in patients with COVID-19 with metabolic syndrome?
Findings In this cohort study including 46 441 patients hospitalised for COVID-19, metabolic syndrome was associated with significantly increased odds of ARDS and death. With each metabolic syndrome criterion added from 1 to 4 criteria, the risk of ARDS significantly increased in an additive fashion.
Meaning These findings suggest that metabolic syndrome and its associated comorbidities were critical risk factors associated with COVID-19–related ARDS and death.
Abstract
Importance
Obesity, diabetes, and hypertension are common comorbidities in patients with severe COVID-19, yet little is known about the risk of acute respiratory distress syndrome (ARDS) or death in patients with COVID-19 and metabolic syndrome.
Objective
To determine whether metabolic syndrome is associated with an increased risk of ARDS and death from COVID-19.
Design, Setting, and Participants
This multicentre cohort study used data from the Society of Critical Care Medicine Discovery Viral Respiratory Illness Universal Study collected from 181 hospitals across 26 countries from February 15, 2020, to February 18, 2021. Outcomes were compared between patients with metabolic syndrome (defined as ≥3 of the following criteria: obesity, pre-diabetes or diabetes, hypertension, and dyslipidaemia) and a control population without metabolic syndrome. Participants included adult patients hospitalised for COVID-19 during the study period who had a completed discharge status. Data were analysed from February 22 to October 5, 2021.
Exposures
Exposures were SARS-CoV-2 infection, metabolic syndrome, obesity, pre-diabetes or diabetes, hypertension, and/or dyslipidaemia.
Main Outcomes and Measures
The primary 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 hospitalised with COVID-19, 29 040 patients (mean [SD] age, 61.2 [17.8] years; 13 059 [45.0%] women and 15713 [54.1%] men; 6797 black patients [23.4%], 5325 Hispanic patients [18.3%], and 16 507 white patients [57.8%]) met inclusion criteria. A total of 5069 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 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 LOS (median [IQR], 8.0 [4.2-15.8] days vs 6.8 [3.4-13.0] days; P < .001) and ICU LOS (median [IQR], 7.0 [2.8-15.0] days vs 6.4 [2.7-13.0] days; P < .001). Each additional metabolic syndrome criterion was associated with increased risk of ARDS in an additive fashion (1 criterion: 1147 patients with ARDS [10.4%]; P = .83; 2 criteria: 1191 patients with ARDS [15.3%]; P < .001; 3 criteria: 817 patients with ARDS [19.3%]; P < .001; 4 criteria: 203 patients with ARDS [24.3%]; P < .001).
Conclusions and Relevance
These findings suggest that metabolic syndrome was associated with increased risks of ARDS and death in patients hospitalised with COVID-19. The association with ARDS was cumulative for each metabolic syndrome criteria present.
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