Outcomes and Prognostic Factors in a Large Cohort of Hospitalized Cancer Patients With COVID-19

Abstract

PURPOSE Patients with cancer are at increased risk for unfavorable outcomes from COVID-19. Knowledge about the outcome determinants of severe acute respiratory syndrome coronavirus 2 infection in this population is essential for risk stratification and definition of appropriate management. Our objective was to evaluate prognostic factors for all-cause mortality in patients diagnosed with both cancer and COVID-19. METHODS All consecutive patients with cancer hospitalized at our institution with COVID-19 were included. Electronic medical records were reviewed for clinical and laboratory characteristics potentially associated with outcomes. RESULTS Five hundred seventy-six consecutive patients with cancer and COVID-19 were included in the present study. An overall in-hospital mortality rate of 49.3% was demonstrated. Clinical factors associated with increased risk of death because of COVID-19 were age over 65 years, Eastern Cooperative Oncology Group performance status > 0 zero, best supportive care, primary lung cancer, and the presence of lung metastases. Laboratory findings associated with a higher risk of unfavorable outcomes were neutrophilia, lymphopenia, and elevated levels of D-dimer, creatinine, C-reactive protein, or AST. CONCLUSION A high mortality rate in patients with cancer who were diagnosed with COVID-19 was demonstrated in the present study, emphasizing the need for close surveillance in this group of patients, especially in those with unfavorable prognostic characteristics.

The Impact of Routine Molecular Screening for SARS-CoV-2 in Patients Receiving Anticancer Therapy: An Interim Analysis of the Observational COICA Study

“…In fact, in 1 retrospective analysis of 557 consecutive COVID-19 patients, of whom 46 had active cancer, an overall fatality rate of 50% (95% CI: 34.9-65.1) versus 20.2% (95% CI: 16.8-23.9) in patients with versus without cancer was reported, with a median OS of 14 versus 35 days, respectively [14]. Consistent results have been obtained by other researchers [15,16]. Finally, in a retrospective case-control study conducted by analyzing medical records of 2,523,920 cancer patients, patients with cancer and COVID-19 had significantly worse outcomes (hospitalization rate, 47.46%; death rate, 14.93%) compared to nononcological patients with COVID-19 (hospitalization rate, 24.26%; death rate, 5.26%) (p < 0.001) [17].…”

“…In this work, we presented clinical outcomes related to SARS-CoV-2 infection in patients receiving systemic antineoplastic treatment at the coordinating center of the COICA study and reported a 9.21% death rate, with 11.84% of patients requiring O 2 therapy, 15.79% requiring to be admitted to the Hospital, and 5.26% being admitted to the ICU. These findings appear to be more favorable compared to those mentioned above [14][15][16][17]. When we explored potential predictors of COVID-19-related outcomes, we found that nonscreening-versus screening-detected SARS-CoV-2 infection was associated with significantly higher odds of death, needing O 2 therapy, being admitted to hospital as well as being admitted to ICU.…”

Mortality and prognostic factors in hospitalized COVID-19 patients with cancer: an analysis from a large healthcare system in the United States

“…Labs such as elevated CRP, elevated creatinine, and lymphopenia were all seen in COVID-19 positive cancer patients and contributed to their poor outcomes. In a large cohort study in Brazil, lymphopenia [2.20 (1.26–3.84)], creatinine elevation [2.86 (1.40–5.84)] and CRP elevation [2.86 (1.40–5.84)] were associated with an increased risk of death and worse prognosis, likely due to an increased inflammatory state and diminished immune response ( 19 ). In our study, the findings demonstrated that older individuals, elevated CRP and creatinine are independently associated with increased risk of in-hospital mortality in cancer patients with COVID-19.…”

Clinical characteristics and outcomes in a cohort of oncologic patients with COVID‐19 during the first year of the pandemic in Mexico

“…6,16 Thirty-nine percent of patients had advanced cancer, similar to that reported in the series by Lee et al 9 in the UK and the report from Nader-Manta from Brazil. 17 T A B L E 3 Univariate analysis of risk factor for 30 days all-cause mortality among hospitalized patients with COVID-19 (N = 172) compared to the results by Kuderer, in which only 11% of patients had active or progressive neoplasia, 6 the proportion of advanced cancer was much higher.…”