Metabolic Syndrome and In-Hospital Mortality in Sepsis: A Multicenter Cohort Study Revealing a Severity-Dependent Survival Advantage Driven by Overweight and Hyperlipidemia.

OBJECTIVES

To evaluate the association between metabolic syndrome (MetS) and in-hospital mortality in sepsis patients and to determine whether this association varies according to disease severity and individual MetS-related components.

DESIGN

Multicenter retrospective cohort study.

SETTING

Three tertiary hospitals in China.

PATIENTS: A total of 2,973 adult patients with sepsis admitted between September 2015 and May 2023.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

MetS was defined according to the criteria of the Chinese Diabetes Society. The primary outcome was in-hospital mortality. Multivariable Cox regression, subgroup analyses, interaction analyses, and Kaplan-Meier survival analyses were performed. MetS was present in 1,309 patients (44.0%). Patients with MetS had a higher in-hospital survival rate than those without MetS (78.4% vs. 72.8%, p = 0.001). After adjustment for potential confounders, MetS remained independently associated with lower in-hospital mortality. A significant interaction was observed between MetS and SOFA-defined severity strata, indicating a severity-dependent association. The survival advantage of MetS was mainly confined to patients with mild-to-moderate sepsis and was primarily driven by overweight and hyperlipidemia. In addition, these 2 metabolic features were associated with more favorable physiologic profiles, including lower inflammatory burden and better preservation of nutritional and cardiometabolic indices.

CONCLUSIONS

MetS was associated with lower in-hospital mortality in sepsis, particularly in patients with mild-to-moderate disease severity. This association appeared to be largely driven by overweight and hyperlipidemia, supporting a stage-specific prognostic role of metabolic phenotypes in sepsis.