Impact of Metabolic Syndrome on COVID-19 Outcomes in Black Patients

Joshua Denson, MD

Research from Tulane University is adding to clinicians’ understanding of the increased risk of adverse outcomes in Black patients with metabolic syndrome during the ongoing coronavirus disease 2019 (COVID-19) pandemic.

After adjustment for age, sex, race, hospital location, and other factors, investigators found patients with metabolic syndrome were 3.4 times more likely to die from COVID-19 than their counterparts without the condition in a study population made up predominantly by non-Hispanic Black patients.

"Together, obesity, diabetes and pre-diabetes, high blood pressure and abnormal cholesterol levels are all predictive of higher incidents of death in these patients. The more of these diagnoses that you have, the worse the outcomes," said lead investigator Joshua Denson, MD, assistant professor of medicine and pulmonary and critical care medicine physician at Tulane University School of Medicine, in a statement. "The underlying inflammation that is seen with metabolic syndrome may be the driver that is leading to these more severe cases."

While many observational studies have examined the impact of diabetes, obesity, and other risk factors with COVID-19 outcomes, Denson and a team of colleagues sought to further this understanding by assessing the impact of metabolic syndrome and each of its individual components on outcomes in COVID-19 patients. Using the World Health Organization (WHO) criteria for metabolic syndrome, investigators designed their study as an assessment of data collected from a pair of Tulane-affiliated hospitals in New Orleans.

Of note, the WHO criteria for metabolic syndrome required the presence of at least 3 of the 5 following factors: hemoglobin A1c of 5.7% or greater or documented history of diabetes or diabetic medication use, a BMI of 30 kg/m2 or greater, a history of hypertension or antihypertensive medication use, triglyceride levels of 150 mg/dL or more, and an HDL level of less than 50 mg/dL for women and less than 40 mg/dL for men or use of a cholesterol-lowering medication with a documented history of hypercholesterolemia.

Choosing a time frame of March 30-April 5, 2020, which investigators noted was the peak of the outbreak in that region, investigators identified a cohort of 287 consecutive patients hospitalized with COVID-19 between the hospitals. The mean age of the study cohort was 61.5 years, 56.8% were female, 85.4% were non-Hispanic Black, and metabolic syndrome was present in 66% of the entire study cohort.

Investigators pointed out the most common conditions present among the study population were hypertension, obesity, diabetes, and low HDL-cholesterol, which were present in 80%, 65%, 54%, and 39% of patients, respectively. In total, 130 patients required admission to an intensive care unit and 108 required invasive mechanical ventilation.

Investigators pointed out the comparison of outcomes was performed using a multivariable logistic regression model adjusted for factors including age, sex, race, individual hospital site, and Charlson Comorbidity Index as covariates.

Upon analysis, presence of metabolic syndrome in patients was significantly associated with mortality (aOR, 3.42; 95% CI, 1.52-7.69), admission into an intensive care unit (aOR, 4.59; 95% CI, 2.53-8.32), invasive mechanical ventilation (aOR, 4.71; 95% CI, 2.50-8.87), and acute respiratory distress syndrome (aOR, 2.44; 95% CI, 2.25-9.82) when compared to patients without metabolic syndrome. Results of the analysis also indicated hypertension, obesity, and diabetes individually showed no association with mortality.

Investigators noted obesity was associated with increased odds of being admitted to an intensive care unit (aOR, 2.18; 95% CI, 1.25-3.81), acute respiratory distress syndrome (aOR, 2.44; 95% CI, 1.28-4.65), and need for invasive mechanical ventilation (aOR, 2.36; 95% CI, 1.33-4.21). Diabetes was associated with admission into an intensive care unit (aOR, 2.22; 95% CI, 1.24-3.98) and need for invasive mechanical ventilation (aOR, 2.12; 95% CI, 1.16-3.89). Conversely, hypertension was not associated with any outcomes of interest.

Additionally, investigators found CRP (aOR, 3.66; 95% CI, 1.22-10.97) and lactate dehydrogenase (aOR, 3.49; 95% CI, 1.78-6.83) were both associated with mortality.

"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," Denson added, in the aforementioned release.

This study, “Metabolic Syndrome and COVID19 Mortality Among Adult Black Patients in New Orleans,” was published in Diabetes Care.