Introduction: Acute respiratory distress syndrome (ARDS) is an inflammatory lung disease associated with high mortality, which has changed minimally over the past decade, thus prompting the exploration of predictive phenotyping for prognostication and therapeutic targeting. Metabolic syndrome (MetS) is associated with chronic inflammation and has been explored as a prognostic marker in ARDS, with conflicting findings in select cohorts. We aimed to assess the population-level association of MetS with mortality in ARDS. Methods: Statewide data were used to identify mechanically ventilated hospitalizations aged ≥18 years with ARDS in Texas during 2020-2023. ARDS was defined by ICD-10 code J80. MetS was defined as presence of ≥3 of the following conditions identified by Clinical Classifications Software Refined categories: obesity (END009), dyslipidemia (END010), diabetes (END002-END006), and hypertension (CIR007-CIR008). Hierarchical logistic models were fit to estimate the association of MetS with short-term mortality (in-hospital death or discharge to hospice) among hospitalizations with ARDS overall, on sensitivity analysis of the number and type of MetS criteria, and for COVID-19 diagnosis. Results: Among 23,052 eligible ARDS hospitalizations, 4,523 (19.6%) had MetS. Compared to ARDS hospitalizations without MetS, those with MetS were older (aged ≥65 years 45.4% vs 38.2%; p < 0.001), more commonly racial or ethnic minority (58.9% vs 57.1%; p = 0.028), and had higher mean SD Deyo Comorbidity Index (1.98 1.96 vs 1.62 2.03; p < 0.001), but lower mean SD number of organ dysfunctions (3.33 1.23 vs 3.42 1.30; p < 0.001). The crude short-term mortality among ARDS hospitalizations with and without MetS was 68.2% and 67.6%, respectively (p = 0.439). On adjusted analyses, MetS was not associated with mortality in ARDS overall (adjusted odds ratio aOR 0.96 95% CI 0.87-1.06) and on sensitivity analyses, except for hypertension (aOR 0.89 95% CI 0.83-0.97), with the latter driven by COVID-19 hospitalizations. Conclusions: MetS was not associated with short-term mortality in patients with ARDS. Whether the severity of MetS and its components modulate ARDS outcomes warrants further studies.
Usman et al. (Sun,) studied this question.