ABSTRACT
RATIONALE: Numerous data regarding both clinical presentation and prognosis of COVID-19 have been published. Most studies focused on individual predictors for mortality. Although some prognostic factors were consistently identified across the different studies such as older age or cardiovascular comorbidities, other discrepancies reflect geographical location of the studies, characteristics of study population, admission in wards and/or intensive care units, and variables incorporated in the statistical model. We aimed to a priori identify specific patient profiles, then assessing their association with the outcomes in COVID-19 patients with respiratory symptoms admitted specifically in hospital wards. METHODS: We conducted a retrospective single center study from February, 27, 2020 to April, 27, 2020. A non-supervised cluster analysis was first used to detect patient profiles based on characteristics at admission of 220 consecutive patients admitted at our institution. Then, we assessed its prognostic value, using Cox regression analyses to predict survival. RESULTS: Three clusters were identified, with 47 patients in cluster 1, 87 in cluster 2, and 86 in cluster 3, and whose presentation differed. Cluster 1 mostly included sexagenarian patients with active malignancy who were admitted early after COVID-19 onset. Cluster 2 included the oldest, overweight patients with high blood pressure and renal insufficiency, while cluster 3 included the youngest patients with gastrointestinal symptoms and delayed admission. These subgroups of patients were associated with different outcomes, with 60 days survival of 74.3% (cluster1), 50.6% (cluster2) and 96.5% (cluster3) (figure 1). This was confirmed by the multivariable Cox analyses that exhibited the prognostic value of those patterns. CONCLUSION: The cluster approach seems appropriate and pragmatic to early identify patient profiles that could help physicians to segregate patients according to their prognosis. Figure 1: Survival since hospital admission according to the clusters .
ABSTRACT
Background: Patients with cancer are more susceptible to infection because of immunosuppressive treatment given to cure cancer. Several guidelines published at the beginning of the COVID-19 pandemic recommend delaying systemic anticancer treatment until complete resolution of COVID-19 symptoms. In addition, it is important to segregate patients with cancer from patients with COVID-19 to avoid transmission. Nevertheless, some patients will present both diseases, and the duration of eviction from cancer units and delay of cancer treatment after COVID-19 remains unclear. Notably the duration of viral excretion after COVID-19 is a concern in immunosuppressed patients. Methods: We tested all patients with a confirmed initial diagnosis of COVID-19 who needed to receive cancer or immunosuppressive treatment for a solid tumour, haematological or inflammatory disease in our centre from April 1st to May 15th 2020. We have repeated SARS-COV2 RT-PCR until negative viral shedding. Results: We tested 49 consecutive patients: 53% had solid tumours, 37% haematological disease and 10% inflammatory disease. 59% were under 65 years. Overall, 82% of patients had a positive RT-PCR from day 14 to 20 after the initial diagnosis of COVID-19 infection, 60% from day 21 to 27 and 30% from day 28 to 34. Only 4/37 patients evaluated remained with a positive RT-PCR after day 35. No predictive factors were associated with a positive RT-PCR but our results suggest that patients treated for inflammatory disease had a shorter duration of positive RT-PCR. 18 patients had their treatment delayed according to guideline recommendations and 17 patients received their treatment in a dedicated COVID-19 outpatient unit. No symptomatic COVID-19 recurrence was observed during follow-up in patients who had received chemotherapy despite persistent positive RT-PCR. Conclusions: We report here the first assessment of SARS-CoV2 RT-PCR kinetic in cancer patients. A prolonged viral excretion is observed in patients treated for cancer. A systematic retest is needed after day 14 if RT-PCR remains positive. A specific unit dedicated to outpatients with persistent positive RT-PCR allows urgent anticancer treatment and avoids the risk of viral exposure for other immunodepressed patients. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.