Metabolic Syndrome and In-Hospital Mortality in Sepsis: A Multicenter Cohort Study Revealing a Severity-Dependent...

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.

Multicenter retrospective cohort study.

Three tertiary hospitals in China.

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

None.

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.

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.