The incidence of COVID-19 in patients with metabolic syndrome and non-alcoholic steatohepatitis: A population-based study ☆

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Abstract

Background

The novel coronavirus disease (COVID-19) emerged from China in 2019 and rapidly spread worldwide. Patients with metabolic comorbid conditions are more susceptible to infection by COVID-19. Metabolic syndrome is a constellation of interlinked metabolic risk factors that predispose patients to increased risk of complications. Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and non-alcoholic steatohepatitis (NASH) is the aggressive form of NAFLD.

Objective

The aim of this study is to determine the relationship between metabolic syndrome components and the risk of COVID-19.

Methods

We reviewed data from a large commercial database (Explorys IBM) that aggregates electronic health records from 26 large nationwide healthcare systems. Using systemized nomenclature of clinical medical terms (SNOMED-CT), we identified adults with the diagnosis of metabolic syndrome and its individual components from 1999-2019. We included patients with the diagnosis of COVID-19 from December 2019 to May 2020. Comorbidities known to be associated with COVID-19 and metabolic syndrome such as obesity, diabetes mellitus, dyslipidemia, smoking, male gender, African American, and hypertension were collected. Univariable and multivariable analyses were performed to investigate whether metabolic syndrome or its individual components are independently associated with the risk of COVID-19.

Results

Out of 61.4 million active adult patients in the database, 8,885 (0.01%) had documented COVID-19. The cumulative incidence of COVID-19 was higher if metabolic syndrome was the primary diagnosis (0.10% vs 0.01% %, OR 7.00 [6.11–8.01]). The adjusted odds (aOR) of having COVID-19 was higher in patients if they were African Americans (OR 7.45 [7.14- 7.77]), hypertensive (aOR 2.53 [2.40 - 2.68]), obese (aOR 2.20 [2.10 2.32]), diabetic (aOR 1.41 [1.33- 1.48]) hyperlipidemic (OR 1.70 [1.56-1.74]) or diagnosed with NASH (OR 4.93 [4.05- 6.00]). There was a slight decrease in adjusted odds of having COVID-19 in males as compared to females (aOR 0.88 [0.84- 0.92]).

Conclusion

The incidence of COVID-19 in patients with metabolic syndrome is high. Among all comorbid metabolic conditions, NASH had the strongest association with COVID-19.

Highlights

•

In the United States, the incidence of COVID-19 among patients with metabolic syndrome or its components is high.
•

Among all metabolic comorbid conditions, non-alcoholic steatohepatitis (NASH) the more aggressive form of non-alcoholic fatty liver disease (NAFLD) is associated with the highest risk of COVID-19.
•

African Americans are disproportionately affected by COVID-19.

Related collections

Most cited references 24

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A Novel Coronavirus from Patients with Pneumonia in China, 2019

Na Zhu, Dingyu Zhang, Wenling Wang … (2020)

Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)

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Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

Zunyou Wu, Jennifer M. McGoogan (2020)

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Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

Xiaobo Yang, Yuan Yu, Jiqian Xu … (2020)

Summary Background An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus 2 (SARS-CoV-2) started in December, 2019, in Wuhan, China. Information about critically ill patients with SARS-CoV-2 infection is scarce. We aimed to describe the clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia. Methods In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between late December, 2019, and Jan 26, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between survivors and non-survivors. The primary outcome was 28-day mortality, as of Feb 9, 2020. Secondary outcomes included incidence of SARS-CoV-2-related acute respiratory distress syndrome (ARDS) and the proportion of patients requiring mechanical ventilation. Findings Of 710 patients with SARS-CoV-2 pneumonia, 52 critically ill adult patients were included. The mean age of the 52 patients was 59·7 (SD 13·3) years, 35 (67%) were men, 21 (40%) had chronic illness, 51 (98%) had fever. 32 (61·5%) patients had died at 28 days, and the median duration from admission to the intensive care unit (ICU) to death was 7 (IQR 3–11) days for non-survivors. Compared with survivors, non-survivors were older (64·6 years [11·2] vs 51·9 years [12·9]), more likely to develop ARDS (26 [81%] patients vs 9 [45%] patients), and more likely to receive mechanical ventilation (30 [94%] patients vs 7 [35%] patients), either invasively or non-invasively. Most patients had organ function damage, including 35 (67%) with ARDS, 15 (29%) with acute kidney injury, 12 (23%) with cardiac injury, 15 (29%) with liver dysfunction, and one (2%) with pneumothorax. 37 (71%) patients required mechanical ventilation. Hospital-acquired infection occurred in seven (13·5%) patients. Interpretation The mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1–2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced. Funding None.

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Author and article information

Journal

Journal ID (nlm-ta): Metabol Open

Journal ID (iso-abbrev): Metabol Open

Title: Metabolism Open

Publisher: The Author(s). Published by Elsevier Inc.

ISSN (Electronic): 2589-9368

Publication date PMC-release: 9 September 2020

Publication date (Electronic): 9 September 2020

Electronic Location Identifier: 100057

Affiliations

[a ]Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH, 44109, USA

[b ]Heart and Vascular Division, Case Western Reserve at Metrohealth Medical Center, Cleveland, OH, 44109, USA

[c ]Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA

[d ]Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, 68198, USA

[e ]Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA

Author notes

[∗ ] Corresponding author. Department of Internal Medicine Case Western Reserve University at MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA.

Article

Publisher ID: S2589-9368(20)30037-2 Publisher ID: 100057

DOI: 10.1016/j.metop.2020.100057

PMC ID: 7480663

PubMed ID: 32924000

SO-VID: eb91c810-09cc-444f-b992-e492adffa0d8

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

History

Date received : 15 June 2020

Date revision received : 17 August 2020

Date accepted : 4 September 2020

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