Background: Mortality due to COVID-19 is higher in patients with hypertension, diabetes, and obesity. These comorbidities are collectively present in metabolic syndrome. The aim of this study is to characterize the association between metabolic syndrome and its surrogate biomarkers with severity of COVID-19 disease course.

Methods: This retrospective study included patients over age 18 who tested for COVID-19 at Cleveland Clinic between March 8 and May 17, 2020. Demographics, labs, hospitalization, intensive care unit (ICU) admission, and death were analyzed.

Results: Of 23282 patients, 3679 (15.8%) tested positive for COVID-19. Metabolic syndrome as defined by modified WHO Criteria was present in 834 (39%) of 2146 with available data. Patients with metabolic syndrome were older, male, African-American, heavier, and had more comorbidities. Metabolic syndrome was associated with higher rates of hospital admission and death (p<0.001). On multivariable analysis, patients with metabolic syndrome had an increase in risk of 77% for hospitalization, 57% for ICU admission, and 81% for death (p<0.001). High AST: ALT and TG: HDL were associated with hospitalization and ICU admission, but not mortality.

Conclusion: Metabolic syndrome is associated with hospitalization and mortality due to COVID-19, even after adjusting for other factors. Obesity, hyperglycemia, dyslipidemia, and hypertension are modifiable risk factors that would reduce mortality from COVID-19.