Endocrine Abstracts

JOINT1144

Background: Patients with metabolic syndrome have a significantly higher risk of severe COVID-19 complications, such as in-hospital mortality and acute kidney injury (AKI). The combination of chronic low-grade inflammation, endothelial dysfunction, and metabolic dysregulation worsens clinical outcomes, increasing the need for early risk assessment and targeted management strategies.

Aim: This study aimed to evaluate mortality and AKI risk in hospitalized COVID-19 patients by developing predictive models and proposing targeted interventions to improve patient outcomes.

Methods: A retrospective case-control study was conducted on 129 hospitalized COVID-19 patients from 2020 to 2021. Patients were classified into survivors (n = 88) and non-survivors (n = 41) for mortality risk analysis, while the AKI group included 19 patients with kidney injury and 110 without. Logistic regression models were developed and validated using receiver operating characteristic (ROC) analysis. The mortality model included respiratory insufficiency (OR 22.6; P <0.001), lymphocyte count (OR 0.000144; P <0.001), C-reactive protein (CRP) (OR 1.2; P <0.001), minimal albumin (OR 0.716; P <0.001), eGFR minimum (OR 0.951; P <0.001), and lung involvement on MSCT above 50% (OR 4.96; P <0.001). The AKI model incorporated respiratory insufficiency (OR 12.3; P <0.001), PADUA score ≥4 (OR 3.9; P <0.01), CRP >100 mg/L (OR 2.7; P = 0.02), and hyperglycemia (OR 1.8; P = 0.04). The models were implemented as web-based calculators and Excel tools to assist clinical decision-making.

Results: Metabolic syndrome significantly influenced outcomes. Patients with respiratory insufficiency had a 22.6-fold increased risk of mortality and a 12.3-fold increased risk of AKI. Hyperglycemia and obesity contributed to AKI risk, reinforcing the need for tight metabolic control, including glucose maintenance below 10 mmol/l, early insulin therapy, and SGLT2 inhibitors for renal protection. CRP levels above 100 mg/L were strongly associated with both mortality (OR 1.2, P <0.001) and AKI (OR 2.7, P = 0.02), supporting the benefit of early anti-inflammatory therapy such as IL-6 blockade with tocilizumab and metformin continuation if tolerated. The mortality risk calculator achieved an AUC of 0.976 (95% CI 0.951-1) with 95% sensitivity and 92.6% specificity, while the AKI model had an AUC of 0.848 (95% CI 0.731-0.944), with 89% sensitivity and 80% specificity. Obese patients demonstrated mortality risks comparable to elderly individuals, emphasizing the need for hospitalization criteria based on MetS severity rather than age alone.

Conclusion: Metabolic syndrome is a critical determinant of COVID-19 severity, significantly increasing mortality and AKI risk. The predictive models developed in this study offer high accuracy and practical clinical application, allowing for early identification of high-risk patients.