Since the start of the COVID-19 pandemic, a lot of studies have been done to try to figure out what health conditions put people at higher risk for worse outcomes. Diabetes has been strongly linked to worse outcomes, including the risk of hospitalization, admission to the intensive care unit (ICU) and death. But less attention has been given to metabolic syndrome, a cluster of conditions linked to a higher risk of both type 2 diabetes and heart disease. The conditions that make up metabolic syndrome include obesity, insulin resistance (a hallmark of type 2 diabetes), hypertension (high blood pressure), abnormal blood lipid (cholesterol and triglyceride) levels, and higher blood markers of inflammation.
There has been plenty of research examining the link between many of the individual conditions that form metabolic syndrome and worse COVID-19 outcomes. But a new study suggests that looking at these conditions together — as metabolic syndrome — is better at predicting outcomes related to COVID-19.
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Greater than the sum of its parts
The study, published in the Journal of Diabetes, aimed to look at the relationship between metabolic syndrome and severe outcomes in COVID-19 — admission to the hospital’s ICU, requiring mechanical ventilation (breathing assistance), or death. Researchers looked at the records of 1,871 people who had been hospitalized for COVID-19 at several different hospitals, which included information on preexisting health conditions as well as outcomes related to their hospitalization. The median age of patients in the study was 66.
The researchers found that among hospitalized COVID-19 patients, those with metabolic syndrome — based on an eligible combination of confirmed diabetes, hypertension, obesity or abnormal lipid levels — were 68% more likely to be admitted to the ICU, 90% more likely to require mechanical ventilation, and 40% more likely to die. Importantly, these numbers were larger than for any of the individual components of metabolic syndrome in this study population. Out of diabetes, hypertension and obesity, only diabetes was found to be significantly linked to a higher risk of severe outcomes in COVID-19 — 56% higher for ICU admission, 63% higher for mechanical ventilation, and 30% higher for death.
For each of the risk calculations, researchers controlled for patients’ age, sex, race, insurance status and smoking status, to make sure that these factors weren’t leading to different outcomes in different groups of patients.
As noted in a Healio article on the study, metabolic syndrome was even more predictive of severe outcomes in patients younger than 65, who were 114% more likely to die than those under 65 without metabolic syndrome. But metabolic syndrome wasn’t linked to a significantly higher risk of death in patients over age 65 — meaning that the higher overall risk of death was due mostly to the higher risk in younger patients.
The researchers also found a higher risk of death in two specific groups of people with metabolic syndrome — women (46% higher) and Black patients (54% higher).
More information, better risk prediction
This study demonstrates why it’s so important to have as much information on patients’ health history as possible — especially when treating them in the hospital for a serious condition like COVID-19. While diabetes alone could help predict severe outcomes, the true magnitude of this risk couldn’t be captured by diabetes alone — and wasn’t seen at all when looking at the other health conditions by themselves.
The study also shows that rather than looking at the risk for severe COVID-19 outcomes in isolation, it’s important to study how the combination of certain factors affects this risk. Metabolic syndrome is already a well established medical condition, yet there still haven’t been many studies looking at this combination of factors. It stands to reason that other combinations of factors that aren’t as closely linked — for example, diabetes and asthma, or diabetes and cancer — haven’t been well studied among hospitalized COVID-19 patients.
While looking at risks for different outcomes during hospitalization may seem academic, there are potential real-world consequences to knowing, or not knowing, these risks. If healthcare providers know that someone is at higher risk for severe COVID-19 outcomes, that patient can be more closely monitored, and possibly even prioritized for certain treatments earlier in their hospital stay.
At the very least, this study shows that healthcare providers should consider metabolic syndrome — and not just diabetes alone — when assessing a hospitalized patient’s risk for outcomes related to COVID-19.
Want to learn more about coronavirus and diabetes? Read our latest COVID-19 updates.
