ABSTRACT
Introduction: Infection with the new coronavirus SARS-CoV-2 leads to the disease COVID-19, the course of which is highly variable and depends on a number of patient-specific risk factors. Tumor patients (pts) are considered to be at risk for a severe course of COVID-19, however represent a heterogenous group with presumably variable risk. The infuence of tumor type, specific cancer treatment modalities and other tumor-specific factors on the outcome of COVID-19 are unknown. Method(s): Pts with proven SARS-CoV-2 infection and established tumor diagnosis are eligible for the multicentric ADHOK coronavirus tumor registry (CoRe). Detailed information about tumor diagnosis and treatment were retrospectively collected. The outcome of the SARS-CoV-2 infection (COVID-19 severity) was graded according to the WHO. Result(s): As of 10 July 2020, 77 pts (54.6% male, 45.4% female) out of 15 german medical institutions were included in the registry. Median age was 71 (range 37-94) years. 49 pts (63.6%) were diagnosed with solid tumors, 28 pts (36.4%) sufered from hematological diseases. Most of the pts registered (59.7%) had active tumor disease, 23% pts were in partial or complete remission. 39 pts (40.3%) were at the time-point of SARS-CoV-2 infection under active tumor treatment, the majority of them (22 pts) were receiving systemic anti-tumor agents. In 55 of the pts (71.4%), the SARS-CoV-2 infection remained either asymptomatic (19 patients), or the course of COVID-19 was mild (20 pts) or moderate (16 pts). In contrast, 22 pts (28.6%) experienced a servere or critical course of the disease, and 14 pts (18.2%) died from the infection. Lethal outcome of COVID-19 was documented in 11 of 49 pts with solid tumors (22.4%) and in 3 of 28 pts (10.7%) with hematological diseases. The mortality of SARS-CoV-2 infection was higher in pts with active tumor disease (10/46 pts, 21.7%) than in those with remission (2/18 pts, 11.1%), but was similar in pts with active tumor treatment (15.5%) versus no active tumor treatment (19.3%). Conclusion(s): The outcome of SARS-CoV-2 infection in pts with tumor diseases is highly variable. In the current registry, a considerable number of asymptomatic and mild infections is documented, suggesting that there may be a group of tumor pts with low risk for complications of COV-ID-19. In contrast, detailed analysis of pts with a severe and lethal course of the disease is required to identify potential factors posing those pts at risk for the infection.
ABSTRACT
Introduction: Cancer patients (pts.) are considered susceptible to severe COVID-19 after SARS-CoV-2 infection, however, represent a heterogeneous population with variable risk. Pts. with active tumor disease and hematological neoplasms are particularly vulnerable to the infection. In a retrospective analysis of the ADHOK coronavirus tumor registry, the absolute neutrophil count (ANC) determined prior to infection showed a strong and independent correlation with COVID-19 mortality (Kiani et al, Cancer Med, in press). Here, we present an extended analysis of pre-infection laboratory parameters and COVID-19 severity in the registry pts., with the aim to establish an objective and easy-to-obtain predictor of infection outcome. Methods: Pts. with malignant tumor disease and PCR-confirmed SARSCoV- 2 infection were included in the registry by 22 German clinical institutions. Detailed information about tumor disease and treatment was collected retrospectively. Results of routine laboratory testing, performed at least 10 days prior to infection, were obtained. The course of SARSCoV- 2 infection was graded according to the WHO. Results: By May 10, 2021, 268 pts. (68% with solid tumors, 32% with hematological neoplasms) were included in the registry. Pre-infection routine laboratory values were available from 166 pts., obtained at a median of 21 days before infection. The pre-infection ANC, the neutrophil-to-lymphocyte ratio, and serum levels of CRP and LDH significantly correlated with COVID-19 severity after infection. In multivariable analysis, the ANC was found to be the strongest prognostic predictor for COVID-19 mortality (ANC > 4,4 /nL: OR 10.5, p=0.02) and was independent of age, sex, tumor activity, and CRP. Combining ANC and CRP to a score of 0, 1, or 2 points allowed to separate three groups of pts. with significantly different COVID-19 mortality (2% vs. 29 % vs. 64%, p< 0.001). Significant association of the 'pre-infection COVID-19 score' with COVID-19-related mortality was consistently found in the first and second waves of the pandemic and, in multivariable analysis, was independent of pre-infection LDH, a surrogate marker for tumor activity. Conclusions: A combined score of pre-infection ANC and CRP, determined as part of routine clinical testing prior to SARS-CoV-2 infection, strongly and consistently correlates with COVID-19 severity in cancer pts. It may serve as an easy-to-obtain parameter for COVID-19 risk assessment of cancer pts. prior to infection.
ABSTRACT
Background: Tumor patients (pts.) are considered susceptible to severe COVID-19 after SARS-CoV-2 infection. However, they represent a heterogeneous group of individuals with variable risk. Identification of vulnerable subgroups is important for prioritization of vaccination strategies and possible early therapeutic intervention after infection. Methods: Tumor pts. with PCRconfirmed SARS-CoV-2 infection were included in the multicentric ADHOK registry by 22 institutions. Detailed information about tumor disease and treatment, as well as routine laboratory parameters determined at least 10 days prior to SARS-CoV-2 infection, was collected retrospectively. The primary endpoint was defined as the outcome of the SARS-CoV-2 infection, graded according to the WHO: asymptomatic, mild, moderate, severe, critical, and COVID-19-related death. Results: Until Feb. 5, 2021, 215 pts. (67% with solid tumors, 33% with hematological neoplasms) were included in the registry. 74% of the pts. had an active malignancy. The course of SARS-CoV-2 infection was rather variable: 66% of the pts. remained asymptomatic or showed a mildto- moderate course, while the rest developed severe or critical disease. The COVID-19-related mortality rate was 24%. Pre-infection routine laboratory values were available for 104 pts., obtained at a median of 21 days before SARSCoV- 2 infection. Compared to COVID-19 survivors, COVID-19 non-survivors showed significantly higher median levels of absolute neutrophil count (ANC: 3.6 vs. 6.4 /nL;p = 0.006, n = 91), neutrophil-to-lymphocyte ratio (NLR: 2.2 vs. 7.2;p = 0.005, n = 75), C-reactive protein (CRP: 9.9 vs. 42.0 mg/L;p = 0.001, n = 104), and lactate dehydrogenase (LDH: 213.0 vs. 267.0 U/L;p = 0.016, n = 78). When categorized by a median split, COVID-19 mortality was significantly higher in pts. with ANC > 4.4 /nL (4% vs. 55%, p < 0.001), NLR > 4.1 (5% vs. 58%, p < 0.001), CRP > 15.4 mg/L (18% vs. 46%, p = 0.003), LDH > 236 U/L (15% vs. 49%, p = 0.003) and lymphocytes < 1.3 /nL (41% vs. 11% p = 0.002). In multivariable analysis, ANC and CRP showed a strong and significant association with COVID-19-related death (OR 23.0 and 7.7, p = 0.007 and 0.029, respectively). To develop an easy-to-apply preinfection score, we combined ANC and CRP and were able to separate three groups of pts. With significantly different COVID-19 outcomes (p < 0.001) (Table). Conclusions: Our results unveil subgroups of tumor pts. who may be at increased risk of severe COVID-19 and point to preinfection routine laboratory parameters with potential prognostic power: ANC and CRP may help identify pts. at risk for severe COVID-19 before SARS-CoV-2 infection.