COVID-19 Outcomes and Mortality in Patients with Metabolic Syndrome in a County-Based Hospital Setting in a Primarily Hispanic Population

Since the onset of the COVID-19 pandemic, it has been reported that those who are overweight, have diabetes mellitus (DM), or underlying vascular diseases were more likely to get severely ill from COVID-19. The goal of our study is to examine the association of these effects with COVID-19 severity in patients with metabolic syndrome (MetS), which is defined by the WHO as having at least 3 of the following 5 criteria: obesity, hypertension, DM, hypertriglyceridemia, and low levels of HDL.

Methods:

A retrospective study was conducted of patients hospitalized for COVID-19 between January 1, 2020 and May 1, 2021 at a regional county hospital in Southern California. In this cohort of 269 patients hospitalized for COVID-19, 44.6% were Female, mean age was 58.4 (IQR, 48-68) years, 63.9% had obesity, 42.4% had hypertension, 40.1% had diabetes, 18.2% had hypertriglyceridemia, and 32.3% had low HDL levels, and 30.9% fit the criteria for MetS. The racial demographic of this population was 78.8% Hispanic, 6.32% African American, 4.46% White and 3.72% Asian. 40 (14.9%) were intubated, 51 (18.9%) required admittance to the intensive care unit (ICU), 140 (52.0%) had acute respiratory failure (ARF), and 49 (18.2%) patients died. Unadjusted significance was assessed with chi-squared statistics. Multivariate logistic regression was used to adjust for race, age, and sex, and to examine the relationship between MetS and the outcome variables: intubation, ICU admittance, ARF, and mortality.

Results:

Unadjusted analysis of this cohort showed that MetS patients, when compared with non-MetS patients, had a higher risk of mortality (25.3% vs. 15.1%; p-value < 0.05), admittance rate to the ICU (27.7% vs. 15.1%; p-value < 0.05), intubation rates (18.1% vs. 13.4%; p-value = 0.3), but a lower incidence of ARF (47.0% vs. 54.3%; p-value =0.3). In multivariate analysis with covariates of age, sex and race, MetS patients were statistically significantly associated with mortality ([OR] 2.38; 95% CI, 1.13-5.01; p-value < 0.05) and requiring ICU care ([OR] 1.99, 95% CI, 1.03-3.84; p-value < 0.05). However, MetS was not significantly associated with intubation ([OR] 1.27; 95% CI, 0.60-2.68; p-value = 0.53) or with ARF ([OR] 0.69; 95% CI, 0.40- 1.19; p-value = 0.18).

Discussion/Conclusion:

Our data suggests that MetS is strongly associated with worse COVID-19 outcomes, in a predominantly hispanic population. Further analysis of individual components of metabolic syndrome may yield a more detailed understanding of the drivers of COVID-19 outcomes. This work contributes to an understanding of the effects of MetS on COVID-19 outcomes in a broader population and community setting.