Metabolic Syndrome and COVID-19 Mortality among Adult Black Patients in New Orleans

Abstract

<b>OBJECTIVE</b> Coronavirus disease 2019 (COVID-19) mortality is high in patients with hypertension, obesity and diabetes mellitus. We examined the association between hypertension, obesity and diabetes, individually and clustered as metabolic syndrome (MetS), and COVID-19 outcomes in patients hospitalized in New Orleans during the peak of the outbreak. <p><b>RESEARCH DESIGN AND METHODS</b> Data were collected from 287 consecutive COVID-19 patients hospitalized at two hospitals in New Orleans, Louisiana from March 30<sup>th</sup> to April 5<sup>th</sup>, 2020. MetS was identified per WHO criteria.</p> <p><b>RESULTS</b> Among 287 patients (mean age, 61.5 years; female, 56.8%; non-Hispanic Black, 85.4%), MetS was present in 188 (66%). MetS was significantly associated with mortality (adjusted odds ratio [aOR]: 3.42, 95% confidence interval [CI]: 1.52-7.69), ICU (aOR: 4.59, CI: 2.53-8.32), invasive mechanical ventilation (IMV) (aOR: 4.71, CI: 2.50-8.87) and acute respiratory distress syndrome (ARDS) (aOR: 4.70, CI: 2.25-9.82), compared with non-MetS. Multivariable analyses of hypertension, obesity and diabetes individually showed no association with mortality. Obesity was associated with ICU (aOR, 2.18, CI, 1.25-3.81), ARDS (aOR, 2.44, CI, 1.28-4.65), and IMV (aOR, 2.36, CI, 1.33-4.21). Diabetes was associated with ICU (aOR, 2.22, CI, 1.24-3.98) and IMV (aOR, 2.12, CI, 1.16-3.89). Hypertension was not significantly associated with any outcome. Inflammatory biomarkers associated with MetS, C-reactive protein (CRP) and lactate dehydrogenase (LDH) were associated with mortality [CRP (aOR, 3.66, CI, 1.22-10.97), LDH (aOR, 3.49, CI, 1.78-6.83)].</p> <p><b>CONCLUSIONS</b> In predominantly Black patients hospitalized for COVID-19, the clustering of hypertension, obesity and diabetes as MetS increased the odds of mortality compared to these comorbidities individually. </p>

COVID-19: Mechanistic Model of the African Paradox Supports the Central Role of the NF-κB Pathway

“…Another specific of Africa’s population is that some typical diseases of the Western population, such as obesity and diabetes, have an apparently lower incidence in Africa than in Western countries (see Figure 3 c) and are particularly rare in Africa’s young population. Various comorbidities, such as hypertension, diabetes, respiratory diseases, cardiovascular diseases, cerebrovascular diseases, kidney diseases, and cancer, have been demonstrated to correlate with significantly higher mortality in COVID-19 patients [ 66 ]. In particular, regarding obesity and diabetes, there is growing evidence suggesting that obese patients face severe COVID-19 symptoms more frequently [ 28 , 29 , 66 , 67 ].…”

“…Various comorbidities, such as hypertension, diabetes, respiratory diseases, cardiovascular diseases, cerebrovascular diseases, kidney diseases, and cancer, have been demonstrated to correlate with significantly higher mortality in COVID-19 patients [ 66 ]. In particular, regarding obesity and diabetes, there is growing evidence suggesting that obese patients face severe COVID-19 symptoms more frequently [ 28 , 29 , 66 , 67 ]. In this context, the significantly lower rate of obesity and related diabetes certainly contributes to the low mortality rate of COVID-19 in Africa.…”

Higher Levels of C-Reactive Protein and Ferritin in Patients with Overweight and Obesity and SARS-CoV-2-Related Pneumonia

“…Ferritin values showed a statistically significant difference between the 3 BMI cat-egories, both considering levels at admission (443 [308-561] 1D]). No significant differences between the 3 BMI groups were observed in the time (in days) between the onset of COVID-19 symptoms and the day in which the maximal value of CRP (9 [7-13] days in normal weight, 11 [8][9][10][11][12][13][14] days in overweight, and 10 [8-13] days in obesity) or ferritin (12 [9][10][11][12][13][14] days in normal weight, 11 [8][9][10][11][12][13][14][15] days in overweight, and 12 [9][10][11][12][13][14][15][16][17] days in obesity) was reached. No other significant differences were observed between BMI classes for all the other biochemical parameters, both at admission and as maximal or minimal values (Table 2), or in the times in which the maximal or minimal value of each parameter was reached (data not shown).…”

Prognostic Value of Leucocyte to High-Density Lipoprotein-Cholesterol Ratios in COVID-19 Patients and the Diabetes Subgroup

“…Consequently, a vicious cycle may occur in severe COVID-19 patients, with neutrophil overproduction resulting in deficiency in HDL-C and further neutrophil activation, which is detrimental to the prognosis of COVID‐19. Third, the NHR has been shown to be associated with many diseases, such as metabolic syndrome ( 12 ) and cardiovascular disease ( 35 , 36 ), which are also known risk factors for severe COVID-19 ( 37 – 39 ).…”