Authors

Joshua L Denson, Tulane University School of Medicine
Aaron S Gillet, Tulane University School of Public Health and Tropical Medicine
Yuanhao Zu, Tulane University School of Public Health and Tropical Medicine
Margo Brown, Tulane University School of Medicine
Thaidan Pham, Tulane University School of Medicine
Yilin Yoshida, Southeast Louisiana Veterans Affairs Healthcare System
Franck Mauvais-Jarvis, Southeast Louisiana Veterans Affairs Healthcare System
Ivor S Douglas, Denver Health Medical Center
Mathew Moore, Tulane University School of Medicine
Kevin Tea, Tulane University School of Medicine
Andrew Wetherbie, Tulane University School of Medicine
Rachael Stevens, Tulane University School of Medicine
John Lefante, Tulane University School of Public Health and Tropical Medicine
Jeffrey G Shaffer, Tulane University School of Public Health and Tropical Medicine
Donna Lee Armaignac, Baptist Health South Florida
Katherine Belden, Thomas Jefferson UniversityFollow
Margit Kaufman, Englewood Health
Smith F Heavner, Prisma Health Upstate
Valerie C Danesh, Baylor Scott & White Health
Sreekanth R Cheruku, UT Southwestern Medical Center
Catherine A St Hill, Allina Health
Karen Boman, Society of Critical Care Medicine
Neha Deo, Mayo Clinic
Vikas Bansal, Mayo Clinic
Vishakha K Kumar, Society of Critical Care Medicine
Allan J Walkey, Boston University School of Medicine
Rahul Kashyap, Mayo Clinic
Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group

Document Type

Article

Publication Date

12-1-2021

Comments

This article is the author’s final published version in JAMA Network Open, Volume 4, Issue 12, December 2021, Article number 40568.

The published version is available at https://doi.org/10.1001/jamanetworkopen.2021.40568. Copyright © American Medical Association.

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.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Language

English

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