ABSTRACT
Background: The world, and Italy on the front lines, is experiencing a major medical emergency due to the SARSCoV-2 outbreak. Cancer patients are one of the potentially most vulnerable cohorts of people, but data about their management are still limited. Patients and methods: In this monocentric retrospective study we included all SARS-CoV-2 oncological patients accepted at the Onco-COVID Unit at San Luigi Gonzaga Hospital, one of the few oncological departments dedicated to cancer patients with SARS-Cov-2 infection in Italy. Clinical data were obtained from medical records available until April 24th, 2020. Results: 20 cancer patients were included. The mean (±SD) age of the patients was 66±14 years, 80% were men. Eight (40%) developed infection in their communities and 12 (60%) during the hospitalization. Lung cancer was the most frequent type of cancer (12, 60%), followed by blood/bone marrow cancer (3, 15%). Eight patients (40%) were symptomatic for COVID-19 at the time of diagnosis and symptoms began 2 (±2) days before. The most common were shortness of breath and diarrhea. Fever was present in 7 patients (35%). Among the 12 asymptomatic patients, 8 (67%) became symptomatic during the hospitalization (mean time of symptoms onset 4 days + 4). C-reactive protein increase was detected in 15 (75%) patients, high lactate dehydrogenase levels in 13 (65%), lymphocytopenia and thrombocytopenia in 6 (30%) and 4 (20%), respectively. Seven patients (35%) were on active anti-tumor treatment, 3 (43%) received anti-tumor therapy within two weeks before SARSCoV-2 positivity, and 2 (29%) continued oncological treatment (TKIs and chemotherapy) after the infection diagnosis. Nine (45%) patients were prescribed hydroxychloroquine and 5 (25%) antiviral therapy with lopinavir/ ritonavir or darunavir/ritonavir. Ten (50%) patients died within a mean of 11 days (+ 8) from the diagnosis of COVID-19 infection. Five patients (25%) have been discharged from the hospital, 4 (20%) of them with the indication to best supportive care and 1(5%) to active antitumor treatment. Conclusions: Our series confirms the high mortality rate among cancer patients with COVID-19. The presence of asymptomatic cases suggests that typical symptoms and fever may not be the only useful parameters to suspect COVID-19 in oncological patients. Our Onco-Covid unit suggests the importance of a tailored and holistic approach for cancer patients, even in a challenging situation like SARS-CoV-2 pandemic.
ABSTRACT
Background: During COVID-19 pandemic, timely diagnosis of SARS-CoV-2 infection was crucial, especially in pts with cancer. Real-time polymerase chain reaction (RT-PCR) on nasopharyngeal swab (NPS) is hampered by ≈30% of false negatives. Clinical and radiological features may identify potentially infected cases in presence of negative test. Materials and methods: We retrospectively retrieved records from 30 pts admitted to our Onco-Covid Unit. Clinical (fever, cough, respiratory failure) and radiological (ground glass opacities-GGO with or without lung consolidation) criteria were assessed. NPS RT-PCR was performed (VIASURE SARS COV-2 RT-PCR Detection Kit) at admission and at 48 hours. Pts underwent laboratory and radiological assessments (chest x-ray, bedside lung ultrasonography, thorax CT scan). Other sources of infection were ruled out (blood cultures, pneumococcal/legionella urinary antigen tests) as well as radiological differential diagnoses (e.g. disease progression). Results: From March 21st to May 9th 2020, 9 NPS negative pts with both clinical and radiological features suggestive for COVID-19 were identified. Mean age was 65.1 (31-78), 4 were female, all with ECOG PS 1. 4 pts had COPD, 8 were stage IV. All pts were on active antitumor treatment. Most common symptoms were dyspnea (n 8), fever (n 5), dry cough (n 3);radiological features include: GGOs alone (n 6), consolidation (n 1), consolidation + GGOs (n 1). 3 pts had baseline lymphopenia, 7 high lactate dehydrogenase, 8 high C-reactive protein. All pts presented with respiratory failure: PaO2/FiO2 ratio <200 (n 3), 200-300 (n 5), > 300 (n 1). All pts received antibiotics (azithromycin + ceftriaxone 3;piperacillin/tazobactam 6), glucocorticoids, O2-therapy: nasal cannula (n 3), Venturi mask (n 2), non-invasive ventilation (n 4). 4 pts died and 5 were discharged from the hospital, 4 with the indication to active antitumor treatment and 1 to best supportive care. Conclusions: High suspicion index is necessary in NSCLC pts with respiratory symptoms during COVID-19 pandemic as NPS may not identify all infected pts and the number of 'gray cases' is expected to increase in Phase II. Clinical and radiological findings correlation is pivotal in this subgroup.
ABSTRACT
BACKGROUND: SARS-CoV-2 infection has caused a global pandemic. Many of the medications identified to treat COVID-19 could be connected with QTc prolongation and its consequences. METHODS: Non-ICU hospitalized patients of the three centres involved in the study from the 19th of March to the 1st of May were included in this retrospective multicentre study. Relevant clinical data were digitally collected. The primary outcome was the incidence of QTc prolongation ≥ 500 ms, the main secondary outcomes were the Tisdale score ability to predict QTc prolongation and the incidence of ventricular arrhythmias and sudden deaths. RESULTS: 196 patients were analysed. 20 patients (10.2%) reached a QTc ≥ 500 ms. Patients with QTc ≥ 500 ms were significantly older (66.7 ± 14.65 vs 76.6 ± 8.77 years p: 0.004), with higher Tisdale score (low 56 (31.8%) vs 0; intermediate 95 (54.0%) vs 14 (70.0%); high 25 (14.2%) vs 6 (30.0%); p: 0.007) and with higher prognostic lab values (d-dimer 1819 ± 2815 vs 11486 ± 38554 ng/ml p: 0.010; BNP 212.5 ± 288.4 vs 951.3 ± 816.7 pg/ml p < 0.001; procalcitonin 0.27 ± 0.74 vs 1.33 ± 4.04 ng/ml p: 0.003). After a multivariate analysis the Tisdale score was able to predict a QTc prolongation ≥ 500 ms (OR 1,358 95% CI 1,076-1,714p: 0,010). 27 patients died because of COVID-19 (13.7%), none experienced ventricular arrhythmias, and 2 (1.02%) patients with concomitant cardiovascular condition died of sudden death. CONCLUSIONS: In our population, a QTc prolongation ≥ 500 ms was observed in a minority of patients, no suspected fatal arrhythmias have been observed. Tisdale score can help in predicting QTc prolongation.