Outcomes of Patients With Active Cancer and COVID-19 in the Intensive-Care Unit: A Multicenter Ambispective Study

Abstract

BackgroundSeveral studies report an increased susceptibility to SARS-CoV-2 infection in cancer patients. However, data in the intensive care unit (ICU) are scarce.Research QuestionWe aimed to investigate the association between active cancer and mortality among patients requiring organ support in the ICU.Study Design and MethodsIn this ambispective study encompassing 17 hospitals in France, we included all adult active cancer patients with SARS-CoV-2 infection requiring organ support and admitted in ICU. For each cancer patient, we included 3 non cancer patients as controls. Patients were matched at the same ratio using the inverse probability weighting approach based on a propensity score assessing the probability of cancer at admission. Mortality at day 60 after ICU admission was compared between cancer patients and non-cancer patients using primary logistic regression analysis and secondary multivariable analyses.ResultsBetween March 12, 2020 and March 8, 2021, 2608 patients were admitted with SARS-CoV-2 infection in our study, accounting for 2.8% of the total population of patients with SARS-CoV-2 admitted in all French ICUs within the same period. Among them, 105 (n=4%) presented with cancer (51 patients had hematological malignancy and 54 patients had solid tumors). 409 of 420 patients were included in the propensity score matching process, of whom 307 patients in the non-cancer group and 102 patients in the cancer group. 145 patients (35%) died in the ICU at day 60, 59 (56%) with cancer and 86 (27%) without cancer. In the primary logistic regression analysis, the odds ratio for death associated to cancer was 2.3 (95%CI 1.24 – 4.28, p=0.0082) higher for cancer patients than for a non-cancer patient at ICU admission. Exploratory multivariable analyses showed that solid tumor (OR: 2.344 (0.87-6.31), p=0.062) and hematological malignancies (OR: 4.144 (1.24-13.83), p=0.062) were independently associated with mortality.InterpretationPatients with cancer and requiring ICU admission for SARS-CoV-2 infection had an increased mortality, hematological malignancy harboring the higher risk in comparison to solid tumors.

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“…Reports have demonstrated that in cancer patients, the immune system undergoes significant alterations due to treatment regimens, inducing an immunocompromised state and enhancing their susceptibility to infections. However, lack of association between cancer and ICU admissions in COVID-19 patients in our study is consistent with a study conducted in France including 17 hospitals [35]. Bronchial Asthma is a chronic inflammatory disease of the respiratory system with several inflammatory cells' involvement such as eosinophils, T-lymphocytes, mast cells, and other inflammatory mediators.…”

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“…Possible explanations for the higher risk of severe COVID-19 outcomes in cancer patients include altered clinical evolution of COVID-19 caused by the cancer treatment, increased risk of secondary infections due to cancer-related immune suppression, and higher risk of thromboembolic events associated with increased mortality in cancer patients. 24 , 27 In addition, cancer patients receiving treatment may have more advanced disease, which may increase their risk of severe COVID-19 outcomes, though they may also be healthier and more capable of tolerating treatment compared with other cancer patients, in particular older and those with high comorbidity.…”

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