The report in Diabetes Care said that patients with a combination of obesity, hypertension and diabetes had more than triple the likelihood of dying from novel coronavirus than similar patients without the conditions.
Tulane University–led researchers conducted the study, which was the first to examine the impact of metabolic syndrome on outcomes for COVID-19 patients. Metabolic syndrome is considered to be a cluster of at least three of five conditions—hypertension, high blood sugar, obesity, high triglycerides and low HDL cholesterol—that increase risk for cardiovascular disease.
“Together, obesity, diabetes and pre-diabetes, high blood pressure and abnormal cholesterol levels are all predictive of higher incidence of death in these patients. The more of these diagnoses that you have, the worse the outcomes,” said lead author Joshua Denson, MD, MS, 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.”
The study team looked at 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. To do that, researchers used data collected from 287 consecutive patients with COVID-19 hospitalized at two hospitals in the Louisiana city—Tulane Medical Center and University Medical Center New Orleans—from March 30 to April 5, 2020.
Results indicate that, among 287 patients—mean age 61.5 years; female, 56.8%; non-Hispanic black, 85.4%—MetS was present in 66%. The most common conditions were hypertension (80%), obesity (65%), diabetes (54%), and low HDL (39%).
Researchers point out that metabolic syndrome was significantly associated with mortality (adjusted odds ratio [aOR] 3.42 [95% CI, 1.52-7.69]); admission to the 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 patients who did not have MetS.
The authors note that 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]), while diabetes was associated with ICU (aOR 2.22 [CI, 1.24-3.98]) and IMV (aOR 2.12 [CI, 1.16-3.89]). Hypertension, on the other hand, 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]), the study advises.
“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,” the authors conclude.
“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,” Dr. Denson added.
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