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Critical Care Medicine

Metabolic Syndrome and Acute Respiratory Distress Syndrome in Hospitalized Patients With COVID-19

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: December 22, 2021

Original Investigation

Article Information and Disclosures

Joshua L. Denson, MD, MS¹;

Aaron S. Gillet, BS;

Yuanhao Zu, MPH²;

Margo Brown, BS¹;

Thaidan Pham, BS¹;

Yilin Yoshida, PhD^3,4;

Franck Mauvais-Jarvis, MD, PhD^3,4;

Ivor S. Douglas, MD^5,6;

Mathew Moore, BS¹;

Kevin Tea, BS¹;

Andrew Wetherbie, BS¹;

Rachael Stevens, BS¹;

John Lefante, PhD²;

Jeffrey G. Shaffer, PhD²;

Donna Lee Armaignac, PhD, APRN⁷;

Katherine A. Belden, MD⁸;

Margit Kaufman, MD⁹;

Smith F. Heavner, MS, RN¹⁰;

Valerie C. Danesh, PhD, RN¹¹;

Sreekanth R. Cheruku, MD, MPH¹²;

Catherine A. St. Hill, DVM, PharmD¹³;

Karen Boman, BS¹⁴;

Neha Deo, BS¹⁵;

Vikas Bansal, MBBS, MPH¹⁵;

Vishakha K. Kumar, MD, MBA¹⁴;

Allan J. Walkey, MD, MSc¹⁶;

Rahul Kashyap, MBBS, MBA¹⁵;

for the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group

Author Affiliations

¹Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
²Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
³Section of Endocrinology and Metabolism, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
⁴Southeast Louisiana Veterans Affairs Healthcare System, New Orleans
⁵Division of Pulmonary Sciences & Critical Care Medicine, Denver Health Medical Center, Denver, Colorado
⁶University of Colorado, Anschutz School of Medicine, Aurora
⁷Center for Advanced Analytics, Baptist Health South Florida, Miami
⁸Division of Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
⁹Englewood Health, Englewood, New Jersey
¹⁰Prisma Health Department of Medicine, Prisma Health Upstate, Greenville, South Carolina
¹¹Baylor Scott & White Health, Department of Nursing, Dallas, Texas
¹²Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, Texas
¹³Department of Care Delivery Research, Allina Health, Minneapolis, Minnesota
¹⁴Society of Critical Care Medicine, Mount Prospect, Illinois
¹⁵Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
¹⁶The Pulmonary Center, Division of Pulmonary, Allergy, Sleep and Critical Care; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts

Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Groupfor the

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Key Points

Question What is the risk of acute respiratory distress syndrome (ARDS) and death in patients with COVID-19 with metabolic syndrome?

Findings In this cohort study including 46 441 patients hospitalized for COVID-19, metabolic syndrome was associated with significantly increased odds of ARDS and death. With each metabolic syndrome criterion added from 1 to 4 criteria, the risk of ARDS significantly increased in an additive fashion.

Meaning These findings suggest that metabolic syndrome and its associated comorbidities were critical risk factors associated with COVID-19–related ARDS and death.

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.

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Article Information

Accepted for Publication: October 12, 2021.

Published: December 22, 2021. doi:10.1001/jamanetworkopen.2021.40568

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Denson JL et al. JAMA Network Open.

Corresponding Author: Joshua L. Denson, MD, MS, Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University School of Medicine, 1430 Tulane Ave, #8509, New Orleans, LA 70112 (jdenson@tulane.edu).

Author Contributions: Dr Denson had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Denson, Gillet, Brown, Pham, Douglas, Bansal.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Denson, Gillet, Zu, Pham, Mauvais-Jarvis, Stevens, Lefante, St. Hill, Boman.

Critical revision of the manuscript for important intellectual content: Denson, Gillet, Zu, Brown, Pham, Yoshida, Mauvais-Jarvis, Douglas, Moore, Tea, Wetherbie, Shaffer, Armaignac, Belden, Kaufman, Heavner, Danesh, Cheruku, Deo, Bansal, Kumar, Walkey, Kashyap.

Statistical analysis: Denson, Gillet, Zu, Yoshida, Wetherbie, Lefante, Shaffer, St. Hill.

Obtained funding: Denson, Danesh, Bansal, Kumar, Walkey.

Administrative, technical, or material support: Denson, Gillet, Brown, Tea, Stevens, Armaignac, Kaufman, Heavner, Danesh, Boman, Deo, Bansal, Kumar, Walkey, Kashyap.

Supervision: Denson, Mauvais-Jarvis, Douglas, Shaffer, Heavner, Danesh, Kumar, Walkey, Kashyap.

Conflict of Interest Disclosures: Dr Denson reported receiving grants from the American Diabetes Association, Society of Critical Care Medicine (SCCM), Gordon and Betty Moore Foundation, and National Institutes of Health (NIH) during the conduct of the study and personal fees from AstraZeneca, GlaxoSmithKline, Guidepoint Global Advisors, and Duke University outside the submitted work. Dr Kaufman reported receiving grants from SCCM during the conduct of the study. Dr Boman reported receiving grants from the Gordon and Betty Moore Foundation and Janssen during the conduct of the study. Dr Kumar reported receiving grants from the Gordon and Betty Moore Foundation and Janssen during the conduct of the study. Dr Walkey reported receiving grants from the Gordon and Betty Moore Foundation during the conduct of the study. Dr Kashyap reported receiving grants from the Gordon and Betty Moore Foundation and Janssen during the conduct of the study. No other disclosures were reported.

Funding/Support: Funding was provided in part by the American Diabetes Association COVID-19 Research Award (award No. 7-20-COVID-053 [Dr Denson] and 7-20-COVID-051 [Dr Mauvais-Jarvis]), the Society of Critical Care Medicine (Dr Denson), the Gordon and Betty Moore Foundation (Drs Denson, Kumar, and Kashyap), Janssen Research & Development (Drs Kumar and Kashyap), National Institutes of Health (grant No. U54 GM104940; [Dr Denson], DK074970 [Dr Mauvais-Jarvis], and DK107444 [Dr Mauvais-Jarvis]), the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the Building Interdisciplinary Research Careers in Women’s Health Scholar (grant No. K12HD043451 [Dr Yoshida]), and a US Department of Veterans Affairs Merit Review Award (award No. BX003725 [Dr Mauvais-Jarvis]).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Group Information: The Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group members are listed in Supplement 2.

Meeting Presentation: Preliminary results from this study have been submitted in the form of an abstract to the 51st Meeting of the Society of Critical Care Medicine–2022 Critical Care Congress, planned for February 6-9, 2022, in San Juan, Puerto Rico.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.