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Multicenter Study

Metabolic Syndrome and Acute Respiratory Distress Syndrome in Hospitalized Patients With COVID-19

Joshua L Denson et al. JAMA Netw Open. .

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 multicenter 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, 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 completed discharge status. Data were analyzed from February 22 to October 5, 2021.

Exposures: Exposures were SARS-CoV-2 infection, metabolic syndrome, obesity, prediabetes or diabetes, hypertension, and/or dyslipidemia.

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 hospitalized 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 hospitalized with COVID-19. The association with ARDS was cumulative for each metabolic syndrome criteria present.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Denson reported receiving grants from the American Diabetes Association, Society of Critical Care Medicine (SCCM), Gordon and Betty Moore Foundation, and National Institutes of Health (NIH) during the conduct of the study and personal fees from AstraZeneca, GlaxoSmithKline, Guidepoint Global Advisors, and Duke University outside the submitted work. Dr Kaufman reported receiving grants from SCCM during the conduct of the study. Dr Boman reported receiving grants from the Gordon and Betty Moore Foundation and Janssen during the conduct of the study. Dr Kumar reported receiving grants from the Gordon and Betty Moore Foundation and Janssen during the conduct of the study. Dr Walkey reported receiving grants from the Gordon and Betty Moore Foundation during the conduct of the study. Dr Kashyap reported receiving grants from the Gordon and Betty Moore Foundation and Janssen during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Cohort of Patients in Viral Respiratory Illness Universal Study Database
Metabolic syndrome was defined as meeting at least 3 of the following criteria: prediabetes (hemoglobin A1c ≥5.7%), diabetes, or diabetic medication use; obesity (body mass index [calculated as weight in kilograms divided by height in meters squared] ≥30); hypertension or antihypertensive medication use; and dyslipidemia.
Figure 2.
Figure 2.. Worst 5-Category Ordinal Scale Scores Among Patients With Metabolic Syndrome vs Control Patients
Score of 5 indicates death; 4, receiving invasive mechanical ventilation or extracorporeal membrane oxygenation; 3, receiving noninvasive ventilation or high-flow oxygen devices; 2, requiring supplemental oxygen; and 1, not requiring supplemental oxygen. A cumulative multivariable model demonstrated a significant increase in the odds that patients with metabolic syndrome would experience a 1-point worse ordinal scale score compared with control patients (crude odds ratio, 1.43 [95% CI, 1.35-1.52]).
Figure 3.
Figure 3.. Additive Associations of Metabolic Syndrome Individual Criteria With Outcomes
Of 4 metabolic syndrome criteria, 5148 patients had 0; 11 040 patients had 1; 7783 patients had 2; 4232 patients had 3; and 837 patients had 4. ICU indicates intensive care unit; NS, not significant. aP < .001. bP < .01.
See this image and copyright information in PMC

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