SCCM Resource Library-Metabolic Syndrome and ARDS in COVID-19

Video Transcription

Hello, and thank you very much for having me speak this morning. My name is Scott Gillette, and I'm an internal medicine resident at Emory in Atlanta.  And as a medical student at Tulane in New Orleans, I had the pleasure of working with Josh Denson, studying metabolic syndrome and COVID-19. I have nothing to disclose.  Today we'll first be defining metabolic syndrome. And then we'll be discussing COVID-19 and metabolic syndrome.  And then finally, look at COVID-19 and metabolic syndrome through a multi-center retrospective review study. So why is metabolic syndrome so important in the United States?  Well, the prevalence of metabolic syndrome is as high as 30% across some regions of the state, of the country, and with rates as high as 40% in certain regions, making this one  of the more prevalent diagnoses in America. And what is metabolic syndrome? Metabolic syndrome is a phenotype of clustering of individual diagnoses, including diabetes,  obesity, high blood pressure, and hyperlipidemia. If a patient meets three of these criteria, individual criteria, they would have met the definition for metabolic syndrome.  And metabolic syndrome is thought to be a disease that leads to increased cytokine production through many pathways, which leads to a state of chronic inflammation.  And in COVID-19, especially severe COVID-19, it is thought that a severe inflammatory response reaction from COVID leads to these severe outcomes.  And so we hypothesize that patients with metabolic syndrome would experience increased rates of ARDS and mortality from COVID-19 compared to those without metabolic syndrome.  And so first, we used a local study of about 300 patients in New Orleans and identified  the individual comorbidities related to metabolic syndrome, and then made a metabolic syndrome phenotype, which is patients who met the definition of that.  And when evaluating for ICU admission, ARDS rates, and invasive mechanical ventilation, it is found that patients with metabolic syndrome experience a significantly higher  rate to those compared to a control population. And then when evaluating for hospital mortality, although not significant, there was an increased rate of hospital mortality.  And so we use those local findings to apply them to the SECM's virus COVID-19 registry,  which is a registry of over 28 countries across 300 hospital sites, having 70,000 hospitalized COVID patients.  And so we use the registry and identified 29,000 patients and divided them into a metabolic syndrome group, as well as a control group, and the control group was patients who met  two or less of the metabolic syndrome criteria. And here, as you see in table one, here's a breakdown of the two groups, as well as their individual diagnosing markers.  Next, we performed a multivariable analysis looking at numerous different outcomes for these patients, comparing the metabolic syndrome group to the control group.  And so when comparing ICU admission rates, ARDS diagnoses, and hospital mortality, we saw a significant increase in those rates for patients with metabolic syndrome compared  to the control. And this includes when adjusting for age, race, sex, ethnicity, as well as hospital size and an Elixhauser comorbidity scale.  Next, we grouped these patients based on the amount of metabolic syndrome diagnoses they met, anywhere from zero to four.  And then we evaluated if there was a stepwise additive effect on these hospital outcomes. And looking at ARDS, when a patient develops one characteristic of metabolic syndrome,  moving up from that, there is a stepwise increase in the rates of ARDS that are statistically significant.  And then focusing in on mortality for when a patient goes from one metabolic syndrome diagnosis to two metabolic syndrome diagnoses, there's a significantly increased rate of  a patient's mortality. Next, we used a modified WHO ordinal scale, which evaluates a patient's worst level of  oxygenation during their hospitalization, going from one, which is no oxygen requirement, to five, which is death, and compared the patients in the metabolic syndrome group to  that same control group. And what we found is across all levels of this modified scale, there is a significant  increase of patients with metabolic syndrome in each of the categories. And then for patients with metabolic syndrome, they are 43% more likely to experience a one-point  increase in their ordinal scale at some point during their hospitalization for COVID-19. And so, what are some take-home points from this presentation?  Well, the first take, the main take-home point is that identifying patients with these individual  diagnoses and clustering them into a diagnosis of metabolic syndrome has very important impact  on their hospitalization and prognostication, as COVID-19, patients with COVID-19 and metabolic syndrome experience significantly higher rates of ARDS.  And not only is it metabolic syndrome or no metabolic syndrome, it's important to identify that there is a stepwise increase in severe outcomes for patients as they accumulate  these metabolic syndrome diagnoses. And moving forward, we anticipate that we can look at patients with metabolic syndrome and ARDS in a non-COVID world.  And I'd be more than happy to take any questions via Twitter or email, they are both listed on the screen here.  And before I conclude, I would like to thank Dr. Denson, as well as the rest of the faculty and staff at Tulane for supporting me through this project.  And finally, for all the faculty and staff that I've worked with as a resident at Emory and specifically Grady, on the front lines of looking at these patients and seeing their  outcomes from COVID-19. And once again, I would like to thank everyone for letting me have the opportunity to speak with you this morning.

Video Summary

The speaker, Scott Gillette, discusses the connection between metabolic syndrome and COVID-19. Metabolic syndrome is a combination of conditions such as diabetes, obesity, high blood pressure, and high cholesterol. Gillette presents findings from a study that shows patients with metabolic syndrome have higher rates of ARDS (acute respiratory distress syndrome) and mortality from COVID-19 compared to those without metabolic syndrome. The study analyzed data from 29,000 patients across 300 hospital sites. The results indicate that as the number of metabolic syndrome diagnoses increases, the risk for severe outcomes also increases. Identifying patients with metabolic syndrome is important for understanding their prognosis and hospitalization needs.

Asset Subtitle

Pulmonary, Infection, Endocrine, 2022

Asset Caption

INTRODUCTION/HYPOTHESIS: Little is known about metabolic syndrome (MetS) and ARDS in COVID-19. We hypothesized MetS was associated with ARDS from COVID-19. METHODS: Multicenter observational cohort study of hospitalized adults from the SCCM Discovery VIRUS: COVID-19 Registry from February 15, 2020, to February 18, 2021. Outcomes were compared between patients with MetS (defined as three or more of the following criteria: obesity, prediabetes/diabetes, hypertension, and dyslipidemia) and a control population without MetS. Outcomes included mortality, ARDS, intensive care unit (ICU) admission, and invasive mechanical ventilation (IMV). RESULTS: Among 181 hospitals in 26 countries, 29,040 patients (female, 45.0%; mean age, 61.2 years; Black, 23.4%) met inclusion criteria. MetS, present in 3,993 (13.8%), were compared with Controls (n=25,047, 86.3%). In adjusted analyses, MetS was associated with increased ARDS (aOR 1.54 [CI 1.41-1.68]), mortality (aOR 1.26 [CI 1.15-1.38]), ICU admission (aOR 1.41 [CI 1.31-1.52]), IMV (aOR 1.60 [CI 1.48-1.74]), and increased hospital (median 8.8 vs 6.7, p < 0.001) and ICU (median 7.0 vs. 6.3, p < 0.001) days. With each additional MetS criterion from 0 to 3, the frequency of ARDS increased in an additive fashion (6.6% to 12.4% to 16.3% to 24.9%, respectively, p < 0.001 for all comparisons). Once a patient met criteria for MetS (at least 3 of 4 criteria), the risk for ARDS plateaued (3 of 4 criteria 24.9% and 4 of 4 criteria 24.9%). When compared to International hospitals, US hospitals were burdened with significantly higher proportions of obesity (48.2% vs. 26.4%), prediabetes/DM (33.7% vs. 31.7), HTN (54.8% vs 45.5), and dyslipidemia (11.1% vs 5.3%). However, patients from non-US hospitals had significantly higher hospital mortality as compared with US hospitals (24.5% vs 15.7%, aOR 1.58 [CI 1.41-1.77]) with similar findings noted when patients were stratified by MetS (34.1% vs 21.3%, aOR 1.49 [CI 1.08-2.06]) CONCLUSION AND RELEVANCE: MetS, diagnosed by the clustering of obesity, prediabetes/DM, HTN, and dyslipidemia, is associated with significantly increased mortality and ARDS in a global population of hospitalized COVID-19 patients. This increased risk appears to be cumulative with the proportion of ARDS increasing with each added MetS criteria.

Meta Tag

Content Type Presentation

Knowledge Area Pulmonary

Knowledge Area Infection

Knowledge Area Endocrine

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Acute Respiratory Distress Syndrome ARDS

Tag Diabetes

Tag Acute Lung Injury

Tag Obesity

Tag COVID-19

Year 2022

Keywords

metabolic syndrome

COVID-19

ARDS

diabetes

obesity

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