Clinical Characteristics, Risk Factors and Cardiac Manifestations of Cancer Patients with COVID-19 (preprint)

Background: Coronavirus disease 2019 (COVID-19) has been associated with cardiovascular features, which may be deteriorated in cancer patients.Methods: We retrospectively assessed 1,244 COVID-19 patients from February 1st to August 31st (140 cancer and 1104 non-cancer patients). Clinical data and laboratory findings were obtained and compared between cancer and non-cancer groups. Risk factors for in-hospital mortality were identified by multivariable COX regression models.Findings: The median age of cancer group was older than that in non-cancer patients [61 (57-67) vs. 56 (40-68), p < 0.001]. For cancer group, 56% were in severe and critical status, while the proportion was 10% for non-cancer group. Cancer patients had increased levels of leukocyte, neutrophil count and BUN (all p < 0.01), while lymphocyte count was significantly lower (p < 0.001). The most common solid tumor types were gastrointestinal cancer (26%), lung cancer (21%), breast and reproductive cancer (both 19%). There is a rising for cardiac biomarkers, including Pro-BNP, cTnI, MYO, CK-MB, and D-Dimer in COVID-19 cancer population, especially in deceased cancer subjects. The 30-day in hospital mortality in cancer group was dramatically raised than that in non-cancer group (12.9% vs. 4.0%, p<0.01). In multivariable COX regression models, fever, disease severity status, underlying diseases were risk factors for mortality. The Pro-BNP and D-Dimer levels were significantly increased in cancer subjects with cardiovascular disease.Interpretation: COVID-19 cancer patients relate to deteriorating conditions, increased risk of admission to intensive care units and in-hospital mortality. They display severely impaired myocardium, damaged heart function and imbalanced homeostasis of coagulation, which warrants more aggressive treatment. Funding: The current work was supported by the National Natural Science Foundation Project of China (Grant No. 81670304) and the Fundamental Research Funds for the Central Universities of China (NO.2042019kf0058).Declaration of Interests: All authors report no relationship or conflict of interest to disclose.Ethics Approval Statement: This study was approved by the National Health Commission of China and the institutional review board at Renmin Hospital of Wuhan University (Wuhan, China).

Analyses of the clinical features and contributing factors in 13 fatal cases of Coronavirus Disease 2019 (preprint)

Objective To investigate the clinical features of and contributing factors in 13 fatal cases of Coronavirus Disease 2019 (COVID-19).Methods The clinical data of 13 patients who died of COVID-19 in Central Theater General hospital, China, between January 4, 2020, and February 24, 2020, were analyzed retrospectively. The data reviewed included clinical manifestations, laboratory test results and radiographic features. The cellular immune function and the expression of inflammatory factors in deceased patients at different stages of the disease were analyzed, and the clinical data and laboratory test results between the deceased group and the moderate group (20 patients), severe group (20 patients) and the critical group (10 patients) were compared.Results Of those who died, the patients consisted of 10 men and 3 women. The average age of those who died was (74±19) years, and 10 patients were over 70 years old (76.9%), which was significantly higher than the ages of patients in the moderate group, severe group and critical group. There were no significant differences in sex ratio and clinical manifestations among the 4 groups. For the patients who died, 9presented with underlying diseases,6 of whom had more than 2 diseases, which was significantly higher than the number of underlying disease in the other groups. On admission, the chest computed tomography (CT) for 8 patients (61.5%) mainly showed multiple patchy ground-glass opacities. When the disease progressed, the ground-glass opacities rapidly developed into diffuse lesions in both lungs. The lymphocyte and CD3 + ,CD4 + , and CD8 + T lymphocyte counts in the peripheral blood of 13 patients were significantly lower than normal levels and decreased more substantially during the disease course based on the levels when admitted (P<0.01). Additionally, the IL-6, D-dimer, C-reactive protein (CRP), lactic acid levels gradually increased, and most peaked before death. There were statistically significant differences in IL-6 expression, lymphocyte count and T lymphocyte subset count between the deceased group and the moderate group, severe group and critical group (P<0.01). However, there were no statistically significant differences in serum CRP lactic acid levels among the 4 groups (P>0.05).The cause of death for most patients was acute respiratory distress syndrome (ARDS) with type I respiratory failure. Three patients eventually developed multiorgan deficiency syndrome (MODS).Conclusion The risk factors of death for COVID-19 patients included older men, more underlying diseases, poor cellular immune function and overexpression of inflammatory factors. The main cause of death in patients with COVID-19 was ARDS, which led to respiratory failure and MODS.