Metabolic syndrome ‘better prognostic indicator’ for severe COVID-19 outcomes
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The odds for severe COVID-19 outcomes are increased for patients with metabolic syndrome, according to a study published in the Journal of Diabetes.
“This study found metabolic syndrome to be a better prognostic indicator for severe disease outcomes in COVID-19 patients than its individual components,” Prateek Lohia, MD, MHA, assistant professor in the division of internal medicine at Wayne State University, told Healio. “This [study] aimed to determine the association between metabolic syndrome and severe disease outcomes: mortality, ICU admission and the need for mechanical ventilation in COVID-19 patients. Patients with metabolic syndrome had a 40% increase in all-cause mortality, 68% increase in the need for critical care services and a 90% increase in the need for mechanical ventilation compared to the patients without metabolic syndrome in our cohort.”
Lohia and colleagues conducted a retrospective study on 1,871 adults (median age, 66 years; 79.9% Black) admitted to four Detroit Medical Center Hospitals with COVID-19 from March 10 to June 30, 2020. Researchers obtained electronic medical records that included demographic information, prior comorbidities, BMI and smoking status. Laboratory values from the first 24 hours of admission were included in the analysis. Outcomes in the study included mortality, mechanical ventilation and ICU admission. Patients were defined as having metabolic syndrome if they had three of the following: a history of diabetes; a history of obesity; a history of hypertension; a triglyceride level of more than 150 mg/dL; or a high-density lipoprotein level of less than 40 mg/dL for men, less than 50 mg/dL for women, or a history of hypercholesterolemia and use of cholesterol-lowering medication.
Metabolic syndrome associated with severe COVID-19 outcomes
Of the study population, 30.6% met the criteria for metabolic syndrome. Hypertension was the most prevalent comorbidity (79.4%), followed by diabetes (42.3%) and hyperlipidemia (27.4%). There was a 32.8% mortality rate in the study cohort, 31.6% were admitted to the ICU and 26.1% needed mechanical ventilation.
In multivariable models, metabolic syndrome was associated with a higher likelihood for mortality (OR = 1.4; 95% CI, 1.11-1.75; P = .004), ICU admission (OR = 1.68; 95% CI, 1.36-2.08; P < .001) and need for mechanical ventilation (OR = 1.9; 95% CI, 1.52-2.37; P < .001) compared with those without metabolic syndrome. Metabolic syndrome was associated with higher odds for mortality in adults younger than 65 years (OR = 2.14; 95% CI, 1.46-3.13; P < .001) but not in those aged at least 65 years. Increased odds for mortality with metabolic syndrome were also found for women (OR = 1.46; 95% CI, 1.04-2.04; P = .03) and Black adults (OR = 1.54; 95% CI, 1.2-1.98; P = .001). The likelihood for ICU admission was higher for those with metabolic syndrome compared with adults without metabolic syndrome in all age groups, both sexes and all ethnicities. The odds for mechanical ventilation were also higher in all subgroups with metabolic syndrome except for white adults.
COVID-19 outcomes and metabolic syndrome components
In analysis of metabolic syndrome’s individual components, diabetes was the only one associated with increased odds for mortality (OR = 1.3; 95% CI, 1.05-1.63; P = .02) and ICU admission (OR = 1.56; 95% CI, 1.27-1.93; P < .001). The likelihood for mechanical ventilation was higher for those with diabetes (OR = 1.63; 95% CI, 1.3-2.03; P < .001) and obesity (OR = 1.37; 95% CI, 1.09-1.72; P = .007) compared with adults without those respective comorbidities. Hypertension and hyperlipidemia were not associated with any severe COVID-19 outcomes.
Adults with diabetes and metabolic syndrome had higher odds for mechanical ventilation (OR = 1.58; 95% CI, 1.15-2.18; P = .005) and ICU admission (OR = 1.42; 95% CI, 1.04-1.93; P = .03) compared with those who had diabetes without metabolic syndrome. There was no significant difference between the two groups for mortality.
“A better understanding of the prognostic indicators of clinical outcomes in COVID-19 patients is critical to help the clinicians in identifying the patients at high risk for developing severe disease,” Lohia said. “The results of our study can aid efficient resource allocation, especially in the underserved areas, where the health resources are already strained due to the ongoing pandemic.”
Lohia said more research is needed to understand the mechanisms behind why metabolic syndrome increases the odds for severe COVID-19 outcomes.
For more information:
Prateek Lohia, MD, MHA can be reached at plohia@med.wayne.edu.
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