Patients hospitalised with COVID-19 who had a combination of high blood pressure, obesity and diabetes were over three times more likely to die from the disease, according to a Tulane University study. The study is the first to look at the impact of metabolic syndrome on outcomes for COVID-19 patients. Metabolic syndrome is a cluster of at least three of five conditions – hypertension, high blood sugar, obesity, high triglycerides and low HDL cholesterol – that increases risk for cardiovascular disease.
"Together, obesity, diabetes and pre-diabetes, high blood pressure and abnormal cholesterol levels are all predictive of higher incidents of death in these patients. The more of these diagnoses that you have, the worse the outcomes," said lead author Dr Joshua Denson, assistant professor of medicine and pulmonary and critical care medicine physician at Tulane University School of Medicine. "The underlying inflammation that is seen with metabolic syndrome may be the driver that is leading to these more severe cases."
Researchers followed outcomes for 287 patients hospitalised for COVID-19 at Tulane Medical Centre and University Medical Centre New Orleans from 30 March to 5 April, which was at the peak of the pandemic in New Orleans. More than 85% of patients in the study identified as non-Hispanic Black. The mean age was 61 years old and almost 57% were women.
The most common conditions were hypertension (80%), obesity (65%), diabetes (54%), and low HDL (39%).
Researchers looked at two groups – those diagnosed with metabolic syndrome and those who weren't. They tracked outcomes including if patients were admitted to an intensive care unit, placed on a ventilator, developed acute respiratory distress syndrome (ARDS) or died from the disease.
Almost 66% of the patients in the study had metabolic syndrome. When these cases were compared with patients without the condition, 56% vs 24% required the ICU, 48% vs 18% required a ventilator, 37% vs 11% developed ARDS, and 26% vs 10% died.
Importantly, after accounting for age, sex, race, hospital location, and other conditions, the patients with metabolic syndrome were 3.4 times more likely to die from COVID-19 than those who didn't have the condition. These patients were also nearly five times more likely to be admitted to an ICU, need a ventilator, or develop ARDS.
The study didn't find an increase in mortality for patients when only one of the conditions clustered with metabolic syndrome were examined alone. However, being obese or having diabetes was associated with increased odds of ICU admission and being put on a ventilator.
"Metabolic syndrome should be considered a composite predictor of COVID-19 lethal outcome, increasing the odds of mortality by the combined effects of its individual components," Denson said.
He would advise anyone who meets the criteria for metabolic syndrome to be vigilant in taking measures to reduce risk or exposure to the coronavirus.
"It doesn't matter if you're young or old — we took that into account," he said. "You really should be extra careful. I would say it should impact both preventing your exposures and, if you end up getting sick, you should probably see your doctor sooner."
Abstract
Objective: Coronavirus disease 2019 (COVID-19) mortality is high in patients with hypertension, obesity, and diabetes. We examined the association between hypertension, obesity, and diabetes, individually and clustered as metabolic syndrome (MetS), and COVID-19 outcomes in patients hospitalized in New Orleans during the peak of the outbreak.
Research Design and Methods: Data were collected from 287 consecutive patients with COVID-19 hospitalized at two hospitals in New Orleans, LA from 30 March to 5 April 2020. MetS was identified per World Health Organization criteria.
Results: Among 287 patients (mean age 61.5 years; female, 56.8%; non-Hispanic black, 85.4%), MetS was present in 188 (66%). MetS was significantly associated with mortality (adjusted odds ratio [aOR] 3.42 [95% CI 1.52–7.69]), intensive care unit (ICU) (aOR 4.59 [CI 2.53–8.32]), invasive mechanical ventilation (IMV) (aOR 4.71 [CI 2.50–8.87]), and acute respiratory distress syndrome (ARDS) (aOR 4.70 [CI 2.25–9.82]) compared with non-MetS. Multivariable analyses of hypertension, obesity, and diabetes individually showed no association with mortality. Obesity was associated with ICU (aOR 2.18 [CI, 1.25–3.81]), ARDS (aOR 2.44 [CI 1.28–4.65]), and IMV (aOR 2.36 [CI 1.33–4.21]). Diabetes was associated with ICU (aOR 2.22 [CI 1.24–3.98]) and IMV (aOR 2.12 [CI 1.16–3.89]). Hypertension was not significantly associated with any outcome. Inflammatory biomarkers associated with MetS, CRP, and lactate dehydrogenase (LDH) were associated with mortality (CRP [aOR 3.66] [CI 1.22–10.97] and LDH [aOR 3.49] [CI 1.78–6.83]).
Conclusions: In predominantly black patients hospitalized for COVID-19, the clustering of hypertension, obesity, and diabetes as MetS increased the odds of mortality compared with these comorbidities individually.
Authors
John Xie, Yuanhao Zu, Ala Alkhatib, Thaidan T Pham, Frances Gill, Albert Jang, Stella Radosta, Gerard Chaaya, Leann Myers, Jerry S Zifodya, Christine M Bojanowski, Nassir F Marrouche, Franck Mauvais-Jarvis, Joshua L Denson
[link url="https://news.tulane.edu/pr/metabolic-syndrome-linked-worse-outcomes-covid-19-patients"]Tulane University material[/link]
[link url="https://care.diabetesjournals.org/content/early/2020/08/18/dc20-1714"]Diabetes Care abstract[/link]