The Impact of Metabolic Syndrome on Clinical Outcome of COVID-19 Patients: A Retrospective Study

Document Type : Original Article


1 Department of Respiratory Medicine, Adesh Medical College and Hospital, Shahbad, India

2 Department of Gastroenterology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Haryana, India

3 Department of Community Medicine, Adesh Medical College and Hospital, Shahbad, India

4 Department of Tuberculosis and Respiratory Disease, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India


Background and aim: The COVID-19 disease has a very high infectivity rate, and the spectrum of the disease symptoms varies from asymptomatic to severe cases of respiratory failure. Metabolic syndrome has been identified as an independent risk factor for severe COVID-19. We studied the relationship between hypertension, diabetes, and obesity, individually and together as a metabolic syndrome, with COVID-19 patients admitted to our hospital.
Materials and methods: We conducted a retrospective observational study involving 204 hospitalized patients with COVID-19 at our tertiary care center. COVID-19 patients were divided into two cohorts, metabolic syndrome and non-metabolic syndrome, according to modified World Health Organization criteria. The outcomes of the analyses were hospital mortality, length of stay in the hospital, need for intensive care unit, invasive mechanical ventilation, and hospital readmissions.
Results: The main finding of our study is that metabolic syndrome patients had significantly greater odds of having hospital mortality (OR=6.59 (2.98-14.55), p=0.025) and hospital readmission (OR=8.17 (1.572-42.51), p=0.013) respectively as compared to non-metabolic syndrome patients. Both hospital mortality and readmissions were regarded as predictors of the severity of COVID-19 disease.
Conclusion: The COVID-19 patients with metabolic syndrome are more prone to hospital mortality and readmission than those with non-metabolic syndrome.


Main Subjects

[1]  Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. Journal of advanced research. 2020;24:91-98. doi: 10.1016/j.jare.2020.03.005.
[2]  Baker DM, Bhatia S, Brown S, Cambridge W, Kamarajah SK, McLean KA, et al. Medical student involvement in the COVID-19 response. The Lancet. 2020;395(10232):1254.
[3]  Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. The Lancet. 2020;395(10223):473-5.
[4]  Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nature medicine. 2020;26(7):1017-32.
[5]  Ofer K, Ronit L, Ophir A, Amir K. Normal body mass index (BMI) can rule out metabolic syndrome: an Israeli cohort study. Medicine. 2019;98(9):e14712. doi: 10.1097/MD.0000000000014712.
[6]  Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS coronavirus. Journal of virology. 2020;94(7):e00127-20.
[7] Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?. The lancet respiratory medicine. 2020 Apr 1;8(4):e21.
[8]  Bansal R, Gubbi S, Muniyappa R. Metabolic syndrome and COVID 19: endocrine-immune-vascular interactions shapes clinical course. Endocrinology. 2020;161(10):1-15.
[9]  Korakas E, Ikonomidis I, Kousathana F, Balampanis K, Kountouri A, Raptis A, et al. Obesity and COVID-19: immune and metabolic derangement as a possible link to adverse clinical outcomes. American Journal of Physiology-Endocrinology and Metabolism. 2020;319(1):E105-9.
[10] Korakas E, Ikonomidis I, Kousathana F, Balampanis K, Kountouri A, Raptis A, et al. Obesity and COVID-19: immune and metabolic derangement as a possible link to adverse clinical outcomes. American Journal of Physiology-Endocrinology and Metabolism. 2020;319(1):E105-9.
[11] Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation. 2005;112(17):2735-52.
[12] Xie J, Zu Y, Alkhatib A, Pham TT, Gill F, Jang A, et al. Metabolic syndrome and COVID-19 mortality among adult black patients in New Orleans. Diabetes care. 2021;44(1):188-93.
[13] Nigro E, Perrotta F, Polito R, D’Agnano V, Scialò F, Bianco A, et al. Metabolic perturbations and severe covid-19 disease: Implication of molecular pathways. International Journal of Endocrinology. 2020.
[14] Naghipour M, Joukar F, Nikbakht HA, Hassanipour S, Asgharnezhad M, Arab-Zozani M, et al. High Prevalence of Metabolic Syndrome and Its Related Demographic Factors in North of Iran: Results from the PERSIAN Guilan Cohort Study. International Journal of Endocrinology. 2021;2021.
[15] Mehata S, Shrestha N, Mehta RK, Bista B, Pandey AR, Mishra SR. Prevalence of the metabolic syndrome and its determinants among Nepalese adults: findings from a nationally representative cross-sectional study. Scientific reports. 2018;8(1). DOI:10.1038/s41598-018-33177-5.
[16] Gao F, Zheng KI, Wang XB, Sun QF, Pan KH, Wang TY, et al. Obesity is a risk factor for greater COVID-19 severity. Diabetes care. 2020;43(7):e72-4.
[17] Zhou Y, Chi J, Lv W, Wang Y. Obesity and diabetes as high‐risk factors for severe coronavirus disease 2019 (Covid‐19). Diabetes/Metabolism Research and Reviews. 2021;37(2):e3377.
[18] Cai Q, Chen F, Wang T, Luo F, Liu X, Wu Q, et al. Obesity and COVID-19 severity in a designated hospital in Shenzhen, China. Diabetes care. 2020;43(7):1392-8.
[19] Chu Y, Yang J, Shi J, Zhang P, Wang X. Obesity is associated with increased severity of disease in COVID-19 pneumonia: a systematic review and meta-analysis. European journal of medical research. 2020;25(1):1-5.
[20] Apicella M, Campopiano MC, Mantuano M, Mazoni L, Coppelli A, Del Prato S. COVID-19 in people with diabetes: understanding the reasons for worse outcomes. The lancet Diabetes & endocrinology. 2020;8(9):782-792.
[21] Santos A, Magro DO, Evangelista-Poderoso R, Saad MJ. Diabetes, obesity, and insulin resistance in COVID-19: molecular interrelationship and therapeutic implications. Diabetology & metabolic syndrome. 2021;13(1):1-4.
[22] Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. Jama. 2020;323(20):2052-9. doi:10.1001/jama.2020.6775.
[23] Petrilli CM, Jones SA, Yang J, Rajagopalan H, O’Donnell L, Chernyak Y, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. Bmj. 2020;369.
[24] Jin JM, Bai P, He W, Wu F, Liu XF, Han DM, et al. Gender differences in patients with COVID-19: focus on severity and mortality. Frontiers in public health. 2020;8:152.
[25] Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and mortality among black patients and white patients with Covid-19. New England Journal of Medicine. 2020;382(26):2534-43. DOI: 10.1056/NEJMsa2011686.