Metabolic syndrome increases risk for ARDS, death in patients hospitalized with COVID-19
In patients hospitalized with COVID-19, metabolic syndrome was associated with an increased risk for acute respiratory distress syndrome and death, according to results of a global study published in JAMA Network Open.
“Our study found that if you have high cholesterol, high blood pressure, mild obesity and prediabetes or diabetes and are hospitalized with COVID-19, you have a one in four chance of developing ARDS, which is significant,” Joshua L. Denson, MD, MS, pulmonary and critical care medicine physician and assistant professor of medicine at Tulane University School of Medicine, New Orleans, said in a related press release. “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 noninvasive ventilation, or high-flow oxygen support, and increased supplemental oxygen use compared to patients without metabolic syndrome.”
The multicenter cohort study identified 29,040 patients hospitalized with COVID-19 (mean age, 61.2 years; 45% women) at 181 hospitals in 26 countries using data from the Society of Critical Care Medicine’s Discover Viral Respiratory Illness Universal Study from February 2020 to February 2021.
Metabolic syndrome was defined as three or more of the following criteria: obesity, prediabetes or diabetes, hypertension and dyslipidemia.
Researchers compared outcomes for patients hospitalized with COVID-19 who had metabolic syndrome (17.5%) and those without metabolic syndrome (82.5%)
The primary outcome was in-hospital mortality. Secondary outcomes included ARDS, ICU admission, invasive mechanical ventilation requirement and hospital length of stay.
In adjusted analyses, metabolic syndrome was associated with increased risk for the following outcomes:
- mortality (adjusted OR = 1.19; 95% CI, 1.08-1.31);
- ARDS (aOR = 1.36; 95% CI, 1.12-1.66);
- ICU admission (aOR = 1.32; 95% CI, 1.14-1.53); and
- invasive mechanical ventilation (aOR = 1.45; 95% CI, 1.28-1.65).
Metabolic syndrome was also associated with prolonged hospital length of stay (median, 8 days vs. 6.8 days; P < .001) and ICU length of stay (median, 7 days vs. 6.4 days; P < .001).
The researchers reported an increased risk for ARDS in an additive fashion for each additional metabolic syndrome criterion, with 10.4% of patients with ARDS and one criterion (P = .83), 15.3% of patients with ARDS and two criterion (P < .001), 19.3% of patients with ARDS and three criterion (P < .001) and 24.3% of patients with ARDS with four criterion (P < .001).
“These important findings are another example of possibilities from pooled data of hundreds of hospitals in detecting meaningful associations during the pandemic,” Rahul Kashyap, MBBS, principal investigator of the Discovery VIRUS: COVID-19 Registry, said in the release. “These findings will assist with efforts for creating national infrastructures for identifying critical illness risk factors and testing novel/repurposed medications to help improve patient outcomes."