Metabolic Syndrome and Acute Respiratory Distress Syndrome in Hospitalized Patients With COVID-19
Authors: Joshua L. Denson, Aaron S. Gillet, Yuanhao Zu, Margo Brown, Thaidan Pham, Yilin Yoshida, Franck Mauvais-Jarvis, Ivor S. Douglas, Mathew Moore, Kevin Tea, Andrew Wetherbie, Rachael Stevens, John Lefante, Jeffrey G. Shaffer, Donna Lee Armaignac, Katherine A. Belden, Margit Kaufman, Smith F. Heavner, Valerie C. Danesh, Sreekanth R. Cheruku, Catherine A. St. Hill, Karen Boman, Neha Deo, Vikas Bansal, Vishakha K. Kumar, Allan J. Walkey, Rahul Kashyap, Jean-Baptiste Mesland, Pierre Henin, Hélène Petre, Isabelle Buelens, Anne-Catherine Gerard, Philippe Clevenbergh, Rolando Claure Del Granado, Jose A Mercado, Esdenka Vega-Terraza, Maria F Iturricha-Caceres, Ruben Garza, Eric Chu, Victoria Chan, Oscar Y Gavidia, Felipe Pachon, Mohamed El Kassas, Ahmed Tawheed, Estela Pineda, Gabina María Reyes Guillen, Helin Archaga Soto, Ana Karen Vallecillo Lizardo, Smitha S Segu, Tuhin Chakraborty, Epcebha Joyce, Phani Sreeharsha Kasumalla, Girish Vadgaonkar, Rekha Ediga, Shilpa Basety, Shwetha Dammareddy, Umamaheswara Raju, Janaki Manduva, Naresh Kolakani, Shreeja Sripathi, Sheetal Chaitanya, Anusha Cherian, Sreejith Parameswaran, Magesh Parthiban, Priya A Menu, Mardul Kumar Daga, Munisha Agarwal, Ishan Rohtagi, Sridhar Papani, Mahesh Kamuram, Kamlesh Kumar Agrawal, Vijendra Baghel, Kirti Kumar Patel, Surapaneni Krishna Mohan, Ekambaram Jyothisree, Nooshin Dalili, Mohsen Nafa, Wataru Matsuda, Reina Suzuki, Masamitsu Sanui, Sho Horikita, Yuki Itagaki, Akira Kodate, Yuki Takahashi, Koyo Moriki, Takuya Shiga, Yudai Iwasaki, Rene Rodriguez-Gutierrez, Jose Gerardo Gonzale, Alejandro Salcido-Montenegro, Adrian Camacho-Ortiz, Fatimah Hassan-Hanga, Hadiza Galadanci, Abubakar Shehu Gezawa, Halima Kabir, Taiwo Gboluwaga Amole, Dalha Gwarzo Haliru, Abdullahi S Ibrahim, Muhammad Sohaib Asghar, Mashaal Syed, Syed Anosh Ali Naqvi, Igor Borisovich Zabolotskikh, Tatiana Sergeevna Musaeva, Razan K Alamoudi, Hassan M AlSharif, Sarah A Almazwaghi, Mohammed S Elsakran, Mohamed A Aid, Mouaz A Darwich, Omnia M Hagag, Salah A Ali, Alona Rocacorba, Kathrine Supena, Efren Ray Juane, Jenalyn Medina, Jowany Baduria, Marwa Ridha Amer, Mohammed Abdullah Bawazeer, Talal I Dahhan, Eiad Kseibi, Abid Shahzad Butt, Syed Moazzum Khurshid, Muath Rabee, Mohammed Abujazar, Razan K Alghunaim, Maal Abualkhair, Abeer Turki AlFirm, Mohammed A Almazyad, Mohammed I Alarifi, Jara M Macarambon, Ahmad Abdullah Bukhari, Hussian A Albahrani, Kazi N Asfina, Kaltham M Aldossary, Marija Zdravkovic Zoran, Viseslaz Popadic, Slobodan Klasnja, Jovana Bojicic, Bojan Kovacevic, Stevanovic Predrag, Dejan S Stojakov, Duska K Ignjatovic, Suzana C Bojicic, Mariana M Bobos, Irina B Nenadic, Milica S Zaric, Marko D Djuric, Vladimir R Djukic, Santiago Y Teruel, Belen C Martin, Uluhan Sili, Huseyin Bilgin, Pinar Ay, Kenneth W Dodd, Nicholas Goodmanson, Kathleen Hesse, Paige Bird, Chauncey Weinert, Nathan Schoenrade, Abdulrahman Altaher, Esmael Mayar, Matthew Aronson, Tyler Cooper, Monica Logan, Brianna Miner, Gisele Papo, Eric M Siegal, Phyllis Runningen, Love A Patel, Roman R Melamed, David M Tierney, Vino S Raj, Narayana Mazumder, Catherine St Hill, Lisa Kirkland, Nova Schmitz, Alena Sigman, Joan Hall, Abhijit A Raval, Andrea Franks, Jennifer M Jarvis, Anmol Kharbanda, Sunil Jhajhria, Zachary Fyffe, Stephen Capizzi, Bethany Alicie, Martha Green, Lori Corckarell, Amelia Drennan, Kathleen Dubuque, Tonya Fambrough, Nikole Gasaway, Briana Krantz, Peiman Nebi, Jan Orga, Margaret Serfass, Alina Simion, Kimberly Warren, Cassie Wheeler, Cj Woolman, Amy B Christie, Dennis W Ashley, Rajani Adiga, Andrew S Moyer, George M Verghese, Andrea Sikora Newsome, Chirsty C Forehand, Rebecca Bruning, Timothy W Jones, Moldovan Sabov, Fatema Zaidi, Fiona Tissavirasingham, Dhatri Malipeddi, Jarrod M Mosier, Karen Lutrick, Beth Salvagio Campbell, Cathleen Wilson, Patrick Rivers, Jonathan Brinks, Mokenge Ndiva Mongoh, Boris Gilson, Donaa Lee Armaignac, Don Parris, Maria Pilar Zuniga, Ilea Vargas, Viviana Boronat, Anneka Hutton, Navneet Kaur, Prashank Neupane, Nohemi Sadule-Rios, Lourdes M Rojas, Aashish Neupane, Priscilla Rivera, Carlos Valle Carlos, Gregory Vincent, Mahesh Amin, Mary E Schelle, Amanda Steadham, Christopher M Howard, Cameron McBride, Jocelyn Abraham, Orlando Garner, Katherine Richards, Keegan Collins, Preethi Antony, Sindhu Mathew, Valerie Danesh, Gueorgui Dubrocq, Amber L Davis, Marissa J Hammers, Ill M McGahey, Amanda C Farris, Elisa Priest, Robyn Korsmo, Lorie Fares, Kathy Skiles, Susan M Shor, Kenya Burns, Melody Flores, Lindsay Newman, Debora A Wilk, Jason Ettlinger, Jaccallene Bomar, Himani Darji, Alejandro Arroliga, Corrie A Dowell, Gabriela Hope Gonzales, Melody Flores Flores, Allan j Walkey, Sushrut S Waikar, Michael A Garcia, Mia Colona, Zoe Kibbelaar, Michael Leong, Daniel Wallman, Kanupriya Soni, Jennifer Maccarone, Joshua Gilman, Ycar Devis, Joseph Chung, Munizay Paracha, David N Lumelsky, Madeline DiLorenzo, Najla Abdurrahman, Shelsey Johnson, Maj Andrew M Hersh, Stephanie L Wachs, Brittany S Swigger, Lauren A Sattler, Michael N Moulton, Kimberly Zammit, Patrick J McGrath, William Loeffler, Maya R Chilbert, Raghavendra Tirupathi, Alymer Tang, Arshad Safi, Cindy Green, Jackie Newell, Naga Ramani, Bhavani Harika Ganti, Rayan E Ihle, Elaine A Davis, Shelda A Martin, Imran A Sayed, Katja M Gist, Larisa Strom, Kathleen Chiotos, Allison M Blatz, Giyoung Lee, Ryan H Burnett, Guy I Sydney, Danielle M Traynor, Salim Surani, Joshua White, Aftab Khan, Rahul Dhahwal, Sreekanth Cheruku, Farzin Ahmed, Chrispoter Deonarine, Ashley Jones, Mohammad Ali Shaikh, David Preston, Jeanette Chin, Vidula Vachharajani, Abhijit Duggal, Prabalini Rajendram, Omar Mehkri, Siddharth Dugar, Michelle Biehl, Gretchen Sacha, Stuart Houltham, Alexander Kind, Kiran Ashok, Bryan Poynter, Mary E Beukemann, Richard Rice, Susan Gole, Valerie Shaner, Adarsh Conjeevaram, Michlelle Ferrari, Narendrakumar Alappan, Steven Minear, Jaime Hernandez-Montfort, Syed Sohaib Nasim, Ravi Sunderkrishnan, Debasis Sahoo, Patrick S Milligan, Sandeep K Gupta, Joy M Koglin, Regina Gibson, Lana Johnson, Felicia Preston, Crimson Scott, Bethany Nungester, Dana D Byrne, Christa A Schorr, Katie Grant, Katherine L Doktar, Maura C Porto, Olgo Kaplan, James E Siegler, Brian Schonewald, Ashley Woodford, Alan Tsai, Savina Reid, Kuntal Bhowmick, Saba Daneshpooy, Cyrus Mowdawalla, Trishna Akshay Dave, Wilhemina Kennedy Connor Crudeli, Chirstopher Ferry, Long Nguyen, Sneha Modi, Niharika Padala, Pavan Jitendra Patel, Belle Lin, Jamie Qiuyun, Fan Mandi Liu, Rasagna Kota, Annesha Banerjee, Steven K Daugherty, Sam Atkinson, Kelly Shrimpton, Sidney Ontai, Brian Contreras, Uzoma Obinwanko, Nneka Amamasi, Amir Sharafi, Sarah Lee, Zahia Esber, Chetna Jinjvadia, Raquel R Bartz, Vijay Krishnamoorthy, Bryan Kraft, Aaron Pulsipher, Eugene Friedman, Sachin Mehta, Margit Kaufman, Gregg Lobel, Nisha Gandhi, Amr Abdelaty, Elizabeth Shaji, Kiana Lim, Juan Marte, Dani Ashley Sosa, David P Yamane, Ivy Benjenk, Nivedita Prasanna, Nicholas Perkins, Prera J Roth, Alain Litwin, Ananda Pariyadath, Phillip Moschella, Trayson Llano, Christine Waller, Kara Kallies, Jonean Thorsen, Alec Fitzsimmons, Haley Olsen, Normal Smalls, Steven Q Davis, Valentina Jovic, Max Masuda, Amanda Hayes, Katharine Nault, Michael Smith, William Snow, Riley Liptak, Hannah Durant, Valerie Pendleton, Alay Nanavati, Risa Mrozowsk, Erica Doubleday, Yuk Min Liu, Sarah Zavala, Esther Shim, Ronald A Reilkoff, Julia A Heneghan, Sarah Eichen, Lexie Goertzen, Scott Rajala, Ghislaine Feussom, Ben Tang, Christine C Junia, Robert Lichtenberg, Hasrat Sidhu, Diana Espinoza, Shelden Rodrigues, Marai Jose Zabala, Daniela Goyes, Ammu Susheela, Buddhi Hatharaliyadda, Naveen Rameshkumar, Amulya Kasireddy, Genessis Maldonado, Lisseth Beltran, Akshata Chaugule, Hassan Khan, Namrata Patil, Ruhi Patil, Rodrigo Cartin-Ceba, Ayan Sen, Fahimeh Talaei, Rahul Kashyap, Juan Pablo Domecq, Ognjen Gajic, Vikas Bansal, Aysun Tekin, Amos Lal, John C O'Horo, Neha N Deo, Mayank Sharma, Shahraz Qamar, Romil Singh, Diana J Valencia Morales, Abigail T La Nou, Marija Bogojevic, Simon Zec, Devang Sanghavi, Pramod Guru, Pablo Morno Franco, Karthik Ganaphadithan, Hollie Saunders, Zachary Fleissner, Juan Garcia, Alejandra Yu Lee Mateus, Siva Naga Yarrarapu, Nirmaljot Kaur, Abhisekh Giri, Mohammed Mustafa Hasan, Ashrita Donepudi, Syed Anjum Khan, Nitesh Kumar Jain, Thoyaja Koritala, Rahul S Nanchal, Paul A Bergl, Jennifer L Peterson, Travis Yamanaka, Nicholas A Barreras, Michael Markos, Anita Fareeduddin, Rohan Mehta, Chakradhar Venkata, Miriam Engemann, Annamarie Mantese, Yasir Tarabichi, Adam Perzynski, Christine Wang, Dhatri Kotekal, Adriana C Briceno Bierwirth, Gabriela M Orellana, Gerardo Catalasan, Shohana Ahmed, Carlos F Matute, Ahmad Hamdan, Ivania Salinas, Genesis Del Nogal, Angel Tejada, Jen-Ting Chen, Aluko Hope, Zoe Tsagaris, Elise Ruen, Aram Hambardzumyan, Nasar A Siddiqi, Lesly Jurado, Lindsey Tincher, Carolyn Brown, Bhagat S Aulakh, Sandeep Tripathi, Jennifer A Bandy, Lisa Kreps, Dwan R Bollinger, Roger Scott Stienecker, Andre G Melendez, Tressa A Brunner, Sue M Budzon, Jessica L Heffernan, Janelle M Souder, Tracy L Miller, Andrea G Maisonneuve, Roberta E Redfern, Jessica Shoemaker, Jennifer Micham, Lynn Kenney, Gabriela Naimy, Kerry P J Pulver, Jennifer Yehle, Alicia Weeks, Terra Inman, Brain L Delmonaco, Anthony Franklin, Mitchell Heath, Antonia L Vilella, Sara B Kutner, Kacie Clark, Danielle Moore, Harry L Anderson, Dixy Rajkumar, Ali Abunayla, Jerrilyn Heiter, Howard A Zaren, Stephanie J Smith, Grant C Lewis, Lauren Seames, Cheryl Farlow, Judy Miller, Gloria Broadstreet, Anthony Martinez, Micheal Allison, Aniket Mittal, Rafael Ruiz, Aleta Skaanland, Robert Ross, Umang Patel, Jordesha Hodge, Krunal Kumar Patel, Shivani Dalal, Himanshu Kavani, Sam Joseph, Michael A Bernstein, Ian K Goff, Matthew Naftilan, Amal Mathew, Debora Williams, Sue Murdock, Maryanne Ducey, Kerianne Nelson, Jason Block, James Mitchel, Connor G O'Brien, Sylvan Cox, Ioana Amzuta, Amish Shah, Ritu Modi, Hassan Al-Khalisy, Pradeep Masuta, Melissa Schafer, Angela Wratney, Kristina L Carter, Michael Olmos, Brittany M Parker, Julio Quintanilla, Tara A Craig, Brendon J Clough, Jeffrey T Jameson, Neha Gupta, Tacy L Jones, Shonda C Ayers, Amy B Harrell, Brent R Brown, Caleb Darby, Kristy Page, Amanda Brown, Jessie McAbee, Katherine A Belden, Michael Baram, Devin M Weber, Rosalie DePaola, Yuwei Xia, Hudson Carter, Aaron Tolley, Mary Ferranti, Mark Steele, Laurie Kemble, Joshua Sethi, Chung Cheng Han, Jaclyn Pagliaro, Abdurrahman Husian, Atul Malhotra, Qais Zawaydeh, Benjamin J Sines, Thomas J Bice, Dragana Markotic, Ivana Bosnjak, Emily A Vail, Susannah Nicholson, Rachelle B Jonas, AnnaRose E Dement, William Tang, Mark DeRose, Robert E Villarreal, Rajany V Dy, Alfredo Lardino, Jill Sharma, Richard Czieki, Julia Christopher, Ryan Lacey, Marwan Mashina, Kushal Patel, Dina Gomaa, Micahel Goodman, Devin Wakefield, Anthony Spuzzillo, John O Shinn II, Azra Bihorac, Tezcan Ozrazgat Baslanti, George Omalay, Haleh Hashemighouchani, Julie S Cupka, Matthew M Ruppert, Patrick W McGonagill, Colette Galet, Janice Hubbard, David Wang, Lauren Allan, Aditya Badheka, Madhuradhar Chegondi, Usman Nazir, Garrett Rampon, Jake Riggle, Nathan Dismag, Ozan Akca, Rainer Lenhardt, Rodrigo S Cavallazzi, Ann Jerde, Alexa Black, Allison Polidori, Haily Griffey, Justin Winkler, Thomas Brenzel, Rodger A Alvarez, Amarilys Alarocon-Calderon, Marie Anne Sosa, Sunita K Mahabir, Mausam J Patel, Pauline Parker, Andre Admon, Sinan Hanna, Rishi Chanderraj, Maria Pliakas, Ann Wolski, Jennifer Cirino, Dima Dandachi, Hariharan Regunath, Maraya N Camazine, Grant E Geiger, Abdoulie O Njai, Baraa M Saad, Faraaz Ali Shah, Byron Chuan, Sagar L Rawal, Manal Piracha, Joseph E Tonna, Nicholas M Levin, Kayte Suslavich, Rachel Tsolinas, Zachary T Fica, Chloe R Skidmore, Renee D Stapleton, Anne E Dixon, Olivia Johnson, Sara S Ardren, Stephanie Burns, Anna Raymond, Erika Gonyaw, Kevin Hodgdon, Chole Houseger, Benjamin Lin, Karen McQuesten, Heidi Pecott- Grimm, Julie Sweet, Sebastian Ventrone, Nita Khandelwal, T Eoin West, Ellen S Caldwell, Lara Lovelace-Macon, Navya Garimella, Denisse B Dow, Murtaza Akhter, Rania Abdul Rahman, Mary Mulrow, Erin M Wilfong, Kelsi Vela, Ashish K Khanna, Lynne Harris, Bruce Cusson, Jacob Fowler, David Vaneenenaam, Glen Mckinney, Imoh Udoh, Kathleen Johnson, Patrick G Lyons, Andrew P Michelson, Sara S Haulf, Lauren M Lynch, Nguyet M Nguyen, Aaron Steinbery, Nicholas Braus, Vishwanath Pattan, Jessica Papke, Ismail Jimada, Nida Mhid, Samuel Chakola, Kevin Sheth, Abdalla Ammar, Mahmoud Ammar, Victor Torres Lopez, Charles Dela Cruz, Akhil Khosla, Samir Gautam
Journal: JAMA Network Open (2021)

<h3>Importance</h3> 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. <h3>Objective</h3> To determine whether metabolic syndrome is associated with an increased risk of ARDS and death from COVID-19. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposures</h3> Exposures were SARS-CoV-2 infection, metabolic syndrome, obesity, prediabetes or diabetes, hypertension, and/or dyslipidemia. <h3>Main Outcomes and Measures</h3> 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). <h3>Results</h3> 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;<i>P</i> &lt; .001) and ICU LOS (median [IQR], 7.0 [2.8-15.0] days vs 6.4 [2.7-13.0] days;<i>P</i> &lt; .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%];<i>P</i> = .83; 2 criteria: 1191 patients with ARDS [15.3%];<i>P</i> &lt; .001; 3 criteria: 817 patients with ARDS [19.3%];<i>P</i> &lt; .001; 4 criteria: 203 patients with ARDS [24.3%];<i>P</i> &lt; .001). <h3>Conclusions and Relevance</h3> 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.