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1.
J Immunother Cancer ; 10(3)2022 03.
Article in English | MEDLINE | ID: covidwho-1736087

ABSTRACT

Anti-COVID-19 vaccination may have functional implications for immune checkpoint inhibitor treatment in patients with cancer. This study was undertaken to determine whether the safety or efficacy of anti-PD-1 therapy is reduced in patients with cancer during COVID-19 vaccination. A large multicenter observational study was conducted in 83 Chinese hospitals between January 28, 2021 and September 30, 2021. A total of 3552 patients were screened and 2048 eligible patients with cancer receiving PD-1 inhibitor treatment were recruited. All enrolled patients had received camrelizumab treatment alone or in conjunction with other cancer therapies. Among these, 1518 (74.1%) patients received the BBIBP-CorV vaccine and were defined as the vaccinated subgroup. The remaining 530 (25.9%) patients did not receive anti-COVID-19 vaccination and were defined as the non-vaccinated subgroup. For all participants, Response Evaluation Criteria in Solid Tumor and Common Terminology Criteria for Adverse Events criteria were used to evaluate the efficacy and safety of camrelizumab treatment, respectively. Propensity score match analysis with the optimal pair matching was used to compare these criteria between the vaccinated and non-vaccinated subgroups. A total of 2048 eligible patients with cancer were included (median age 59 years, 27.6% female). Most patients (98.8%) had metastatic cancer of the lung, liver or intestinal tract. Aside from the PD-1 inhibitor treatment, 55.9% of patients received additional cancer therapies. 1518 (74.1%) patients received the BBIBP-CorV vaccine with only mild side effects reported. The remaining patients did not receive COVID-19 vaccination and had a statistically greater percentage of comorbidities. After matching for age, gender, cancer stage/types, comorbidity and performance status, 1060 patients (530 pairs) were selected for propensity score match analysis. This analysis showed no significant differences in overall response rate (25.3% vs 28.9%, p=0.213) and disease control rate (64.6% vs 67.0%, p=0.437) between vaccinated and non-vaccinated subgroups. Immune-related adverse events (irAEs) were reported in both subgroups after camrelizumab treatment. Among vaccinated patients who experienced irAEs, the median interval between the first dose of camrelizumab treatment and the first vaccine shot was ≤16 days. Compared with the non-vaccinated subgroup, irAEs in vaccinated patients were more frequently reported as mild (grade 1 or 2 irAEs; 33.8% vs 19.8%, p<0.001) and these patients were less likely to discontinue the PD-1 inhibitor treatment (4.2% vs 20.4%, p<0.001). Severe irAEs (grade 3 irAE or higher) related to camrelizumab treatment were reported, however no significant differences in the frequency of such events were observed between the vaccinated and non-vaccinated subgroups. The COVID-19 vaccine, BBIBP-CorV, did not increase severe anti-PD-1-related adverse events nor did it reduce the clinical efficacy of camrelizumab in patients with cancer. Thus, we conclude that patients with cancer need not suspend anti-PD-1 treatment during COVID-19 vaccination.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Immune Checkpoint Inhibitors/therapeutic use , Neoplasms/drug therapy , Programmed Cell Death 1 Receptor/antagonists & inhibitors , SARS-CoV-2 , Vaccines, Inactivated/therapeutic use , Aged , Female , Humans , Male , Middle Aged , Treatment Outcome , Vaccination
2.
Front Bioeng Biotechnol ; 10: 780751, 2022.
Article in English | MEDLINE | ID: covidwho-1690462

ABSTRACT

More than 200 million people have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 4 million deaths have been reported worldwide to date. Cathepsin B/cathepsin L (CTSB/L) are SARS-CoV-2 entry-associated proteases and facilitate SARS-CoV-2 to infect host cells. However, the expressions of CTSB/L in healthy individuals and cancer patients remain not fully elucidated yet. Here, we comprehensively profiled the expressions and distributions of CTSB/L in human normal tissues, cancer tissues, and cell lines. Moreover, we compared CTSB/L expressions between various cancers and matched normal tissues, and investigated their genetic alteration and prognostic values in pan-cancer. Finally, we also explored the correlation between CTSB/L expressions and immune infiltration. We found that CTSB was highly expressed in most tissues, and CTSL was highly expressed predominantly in the digestive, urinary, and respiratory systems, such as the lungs, liver and gallbladder, and kidney tissues in the translational level. Moreover, cancer patients may be more susceptible to SARS-CoV-2 infection. Our data suggested that CTSB/L are overexpressed in aerodigestive and genitourinary cancers when compared with that in matched normal tissues, and their expressions were closely related to the prognosis of some cancer types. Interestingly, CTSB/L expressions were significantly correlated with immune cell infiltration in manifold cancer tissues and their corresponding normal tissues. In conclusion, our study shows a comprehensive bioinformatic analysis of two important SARS-CoV-2 entry-related proteases, which could provide a potential indication on prevention of SARS-CoV-2 infection.

3.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-316850

ABSTRACT

Background: Novel coronavirus (COVID-19) infection is a global public health issue and has now affected more than 70 countries worldwide. Severe adult respiratory syndrome-CoV-2 (SARS-CoV-2) pneumonia is associated with high risk of mortality. However, prognostic factors assessing poor clinical outcomes of individual patients with SARS-CoV-2 pneumonia remain unclear. Methods: : We conducted a retrospective, multicenter study of patients with SARS-CoV-2 who were admitted to four hospitals in Wuhan, China from December 2019 to February 2020. Mortality at the of end of follow up period was the primary outcome. Prognostic factors for mortality were also assessed and a prognostic model was developed, calibrated and validated. Results: : The study included 492 patients with SARS-CoV-2, which were divided into three cohorts, the training cohort (n=237), the validation cohort 1 (n=120), and the validation cohort 2 (n=135). Multivariate analysis showed that five clinical parameters were predictive of mortality at the end of follow up period, including age, odds ratio (OR), 1.1 / years increase (p<0.001);neutrophil-to-lymphocyte ratio OR, 1.14 (p<0.001), body temperature on admission OR, 1.53 / °C increase (p=0.005), increase of aspartate transaminase OR, 2.47 (p=0.019), and decrease of total protein OR, 1.69 (p=0.018).Furthermore, the prognostic model drawn from the training cohort was validated with the validation cohort 1 and 2 with comparable area under curve (AUC) at 0.912, 0.928, and 0.883, respectively. While individual survival probabilities were assessed, the model yielded a Harrell’s C index of 0.758 for the training cohort, 0.762 for the validation cohort 1, and 0.711 for the validation cohort 2, which were comparable among each other. Conclusions: : A validated prognostic model was developed to assist in determining the clinical prognosis for SARS- CoV-2 pneumonia. Using this established model, individual patients categorized in the high risk group were associated with an increased risk of mortality, whereas patients predicted in the low risk group had a high probability of survival.

4.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-316849

ABSTRACT

Background: Elderly patients infected with COVID-19 are reported to be facing a substantially increased risk of mortality. Clinical characteristics, treatment options, and potential survival factors remain under investigation. This study aimed to fill this gap and provide clinically relevant factors associated with survival of elderly patients with COVID-19.MethodsIn this multi-center study, elderly patients (age ≥65 years old) with laboratory-confirmed COVID-19 from 4 Wuhan hospitals were included. The clinical end point was hospital discharge or deceased with last date of follow-up on Mar. 08, 2020. Clinical, demographic, and laboratory data were collected.Univariate and multivariate analysis were performed to analyze survival and risk factors. A metabolic flux analysis using a large-scale molecular model was applied to investigate the pathogenesis of SARS- CoV-2 with regard to metabolism pathways.ResultsA total of 223 elderly patients infected with COVID-19 were included, 91 (40.8%) were discharged and 132 (59.2%) deceased. Acute respiratory distress syndrome (ARDS) developed in 140 (62.8%) patients, 23 (25.3%) of these patients survived. Multivariate analysis showed that potential risk factors were D- Dimer (odds ratio: 1.13 [95% CI 1.04 - 1.22], p=.005), immune-related metabolic index (6.42 [95% CI 2.66 - 15.48], p<.001), and neutrophil-to-lymphocyte ratio (1.08 [95% 1.03 - 1.13], p<.001). Elderly patients receiving interferon atmotherapy showed an increased probability of survival (0.29 [95% CI0.17 - 0.51], p<.001). Based on these factors, an algorithm (AlgSurv) was developed to predict survival for elderly patients. The metabolic flux analysis showed that 12 metabolic pathways including phenylalanine (odds ratio: 28.27 [95% CI 10.56 - 75.72], p<0.001), fatty acid (15.61 [95% CI 6.66 - 36.6], p<0.001), and pyruvate (12.86 [95% CI 5.85 - 28.28], p<0.001) showed a consistently lower flux in the surviving versus the deceased subgroup. This may reflect a key pathogenesis of COVID-19 infection.ConclusionAlthough a high mortality has been reported for elderly patients with COVID-19, in this analysis, several factors such as interferon atmotherapy and activity of metabolic pathways were found to be associated with survival of elderly patients. Based on these findings, the survival algorithm (AlgSurv) was developed to assist the clinical stratification for elderly patients. Deregulation of metabolic pathways revealed in this study may aid in the drug development against COVID-19.

5.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-323624

ABSTRACT

Background: Experimental biological research and clinical trials that relied on the healthcare system, access to public laboratory equipment, and adequate space were particularly affected by the COVID-19 pandemic and mobility restrictions. The study is to analyze the influence of COVID-19 on medical research by exploring the clinical trials and articles published by medical researchers worldwide during the COVID-19 pandemic. Methods: Routinely conducted, deferred, and terminated clinical trial statistics from the Cancer Center of Tongji Hospital were collected during the COVID-19 pandemic. The number of global medical articles published in 2020 and those from the previous five years were analyzed according to the PubMed database. To conduct subgroup analyses, the articles were classified according to type and research field. Results: The total number of publications per month in 2020 increased compared to the number of articles published in 2019. However, a decrease in the number of clinical trials was noted. Reviews and research papers increased by 7.28% and 20.60%, respectively. The number of clinical trial published decreased by 62.29%. The proportion of cancer-related publications (38.44% vs. 44.79%) decreased, whereas the proportion of immunology, pulmonology, and emergency publications (19.23% vs. 17.48%) increased. In the Cancer Center of the Tongji Hospital in Wuhan during the COVID-19 pandemic, of the 46 clinical trials analyzed, 37 (80.40%) were delayed, 8 (17.40%) were remote, and 1 (2.20%) was routine. Conclusions: The COVID-19 pandemic had promoted the publication of medical research articles especially those related to the immunology, pulmonology, and emergency medicine. It had a pronounced negative impact on the execution and publication of clinical trials.

6.
Front Bioeng Biotechnol ; 9: 744659, 2021.
Article in English | MEDLINE | ID: covidwho-1686450

ABSTRACT

Kidney renal clear cell carcinoma (KIRC) is a common aggressive malignancy of the urinary system. COVID-19, a highly infectious and severe disease caused by SARS-CoV-2, has become a significant challenge for global public health. Cancer patients have been reported to be more vulnerable to SARS-CoV-2 infection and have a higher risk for serious complications than the general population. However, the correlation between KIRC and COVID-19 remains incompletely elucidated. In this study, we comprehensively investigated the expression and prognostic significance of 333 SARS-CoV-2 infection-related genes in KIRC using the TCGA dataset and identified 31 SARS-CoV-2-related differently expressed genes between KIRC and normal renal tissues. Based on these genes, we constructed and validated a 5-gene prognostic signature (including ACADM, CENPF, KDELC1, PLOD2, and TRMT1) to distinguish low- and high-risk KIRC patients of poor survival in TCGA and E-MTAB-1980 cohorts. Gene set enrichment analysis (GSEA) showed that some inflammatory/immune-related pathways were significantly enriched in the high-risk group. The ESTIMATE analysis indicated that patients in the high-risk group had higher stromal and immune cell scores, therefore lower tumor purity. Moreover, they presented higher proportions of macrophages M0, regulatory T cells (Tregs), and T follicular helper cells and higher expression of immune checkpoints CTLA-4, LAG-3, TIGIT, and PDCD1 than low-risk patients. Besides, we also developed a nomogram to expand clinical applicability, which exhibits excellent predictive accuracy for survival. In conclusion, we identified a novel prognostic signature and nomogram based on SARS-CoV-2-related genes as reliable prognostic predictors for KIRC patients and provided potential therapeutic targets for KIRC and COVID-19.

7.
Front Med (Lausanne) ; 8: 617689, 2021.
Article in English | MEDLINE | ID: covidwho-1241174

ABSTRACT

Background: Currently, a large number of hospitalized coronavirus infectious disease-2019 (COVID-19) patients have met the clinical discharge criteria and have been discharged. Little is known about the sequelae and herd immunity, two important factors influencing the life quality and safety of COVID-19 survivors. Methods: Discharged COVID-19 patients from four medical facilities in Wuhan, China, were followed in order to record and investigate possible post-COVID-19 sequelae and herd immunity. After hospital discharge, patients reported to Fangcang shelter hospitals for an initial 14-day period of mandatory clinical monitoring. After release from these shelter hospitals, patients returned home for self-quarantine. Real-time quantitative PCR (RT-qPCR) was used for severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) detection. Colloidal gold-based immunochromatographic strip assay (ICGSA) was used for anti-SARS-CoV-2 immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody testing. The data for this study are derived from case reports, medical records, and self-reports. Results: A total of 3,677 COVID-19 survivors [median age = 59 years, interquartile range (IQR) = 47-68, range = 10-98; 55.5% female] who were released from four hospitals in Wuhan, China, between January 18 and March 29, 2020 were followed for a median of 144 days (IQR = 135-157). During follow-up, 976 (26.5%) patients had at least one post-COVID-19 sequela. The incidence of post-COVID-19 sequelae among elderly COVID-19 survivors (age ≥60 years) was slightly increased compared to that of young COVID-19 survivors (age <60 years; relative risk = 1.05, 95% CI = 1.02-1.10, p = 0.007). During follow-up, a dramatic reduction of anti-SARS-CoV-2 IgG (88.0%, 95% CI = 84.2-90.4) and IgM (93.2%, 95% CI = 88.5-96.4) antibodies was observed. Among these COVID-19 survivors, 1.2% (n = 45) retested positive for SARS-CoV-2 and 1.0% (n = 37) died during follow-up. Of those who died during follow-up, 70.3% were male and all were negative for both IgG and IgM, except for one person who was IgG-positive. Conclusions: Our study documents significant post-COVID-19 sequelae that impair functions of multiple organ systems in COVID-19 survivors, suggesting that the long-term effects of this disease will negatively impact survivors' quality of life, continue to strain health care systems, and result in extended periods of lost productivity. Furthermore, female gender and anti-SARS-CoV-2 immunity may play an essential role in the survival after COVID-19 infection.

8.
World Psychiatry ; 20(1): 139-140, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1059198
9.
Front Med (Lausanne) ; 7: 595503, 2020.
Article in English | MEDLINE | ID: covidwho-1054985

ABSTRACT

Background: Elderly patients infected with COVID-19 are reported to be facing a substantially increased risk of mortality. Clinical characteristics, treatment options, and potential survival factors remain under investigation. This study aimed to fill this gap and provide clinically relevant factors associated with survival of elderly patients with COVID-19. Methods: In this multi-center study, elderly patients (age ≥65 years old) with laboratory-confirmed COVID-19 from 4 Wuhan hospitals were included. The clinical end point was hospital discharge or deceased with last date of follow-up on Jul. 08, 2020. Clinical, demographic, and laboratory data were collected. Univariate and multivariate analysis were performed to analyze survival and risk factors. A metabolic flux analysis using a large-scale molecular model was applied to investigate the pathogenesis of SARS-CoV-2 with regard to metabolism pathways. Results: A total of 223 elderly patients infected with COVID-19 were included, 91 (40.8%) were discharged and 132 (59.2%) deceased. Acute respiratory distress syndrome (ARDS) developed in 140 (62.8%) patients, 23 (25.3%) of these patients survived. Multivariate analysis showed that potential risk factors for mortality were elevated D-Dimer (odds ratio: 1.13 [95% CI 1.04 - 1.22], p = 0.005), high immune-related metabolic index (6.42 [95% CI 2.66-15.48], p < 0.001), and increased neutrophil-to-lymphocyte ratio (1.08 [95% 1.03-1.13], p < 0.001). Elderly patients receiving interferon atmotherapy showed an increased probability of survival (0.29 [95% CI 0.17-0.51], p < 0.001). Based on these factors, an algorithm (AlgSurv) was developed to predict survival for elderly patients. The metabolic flux analysis showed that 12 metabolic pathways including phenylalanine (odds ratio: 28.27 [95% CI 10.56-75.72], p < 0.001), fatty acid (15.61 [95% CI 6.66-36.6], p < 0.001), and pyruvate (12.86 [95% CI 5.85-28.28], p < 0.001) showed a consistently lower flux in the survivors vs. the deceased subgroup. This may reflect a key pathogenic mechanism of COVID-19 infection. Conclusion: Several factors such as interferon atmotherapy and recreased activity of specific metabolic pathways were found to be associated with survival of elderly patients. Based on these findings, a survival algorithm (AlgSurv) was developed to assist the clinical stratification for elderly patients. Dysregulation of the metabolic pathways revealed in this study may aid in the drug and vaccine development against COVID-19.

11.
Sci Rep ; 10(1): 22451, 2020 12 31.
Article in English | MEDLINE | ID: covidwho-1003312

ABSTRACT

Novel coronavirus 2019 (COVID-19) infection is a global public health issue, that has now affected more than 200 countries worldwide and caused a second wave of pandemic. Severe adult respiratory syndrome-CoV-2 (SARS-CoV-2) pneumonia is associated with a high risk of mortality. However, prognostic factors predicting poor clinical outcomes of individual patients with SARS-CoV-2 pneumonia remain under intensive investigation. We conducted a retrospective, multicenter study of patients with SARS-CoV-2 who were admitted to four hospitals in Wuhan, China from December 2019 to February 2020. Mortality at the end of the follow up period was the primary outcome. Factors predicting mortality were also assessed and a prognostic model was developed, calibrated and validated. The study included 492 patients with SARS-CoV-2 who were divided into three cohorts: the training cohort (n = 237), the validation cohort 1 (n = 120), and the validation cohort 2 (n = 135). Multivariate analysis showed that five clinical parameters were predictive of mortality at the end of follow up period, including advanced age [odds ratio (OR), 1.1/years increase (p < 0.001)], increased neutrophil-to-lymphocyte ratio [(NLR) OR, 1.14/increase (p < 0.001)], elevated body temperature on admission [OR, 1.53/°C increase (p = 0.005)], increased aspartate transaminase [OR, 2.47 (p = 0.019)], and decreased total protein [OR, 1.69 (p = 0.018)]. Furthermore, the prognostic model drawn from the training cohort was validated with validation cohorts 1 and 2 with comparable area under curves (AUC) at 0.912, 0.928, and 0.883, respectively. While individual survival probabilities were assessed, the model yielded a Harrell's C index of 0.758 for the training cohort, 0.762 for the validation cohort 1, and 0.711 for the validation cohort 2, which were comparable among each other. A validated prognostic model was developed to assist in determining the clinical prognosis for SARS-CoV-2 pneumonia. Using this established model, individual patients categorized in the high risk group were associated with an increased risk of mortality, whereas patients predicted to be in the low risk group had a higher probability of survival.


Subject(s)
COVID-19/mortality , Models, Statistical , Mortality , Aged , China , Female , Hospitalization/statistics & numerical data , Humans , Lymphopenia/pathology , Male , Middle Aged , Multivariate Analysis , Prognosis , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2 , Survival Rate
12.
Aging (Albany NY) ; 12(23): 24462-24474, 2020 11 24.
Article in English | MEDLINE | ID: covidwho-1000738

ABSTRACT

COVID-19 caused by severe acute respiratory syndrome coronavirus 2 has developed into a global pandemic. COVID-19 poses a huge threat to health care, and the shortage of medical resources caused by COVID-19 brought serious secondary disasters to elderly cancer patients who are particularly dependent on medical resources. The clinical challenges of cancer management, including aging, immunosuppression, and comorbidities, make cancer patients more vulnerable to COVID-19 with different clinical manifestations, disease severity, and outcomes. The review comprehensively analyzed the characteristics of the cancer patients under the pandemic and concluded that cancer patients were more susceptible to COVID-19, and also concluded that they were more likely to develop poor outcomes and the severe form of the disease. Three basic management strategies have been proposed to protect susceptible elderly cancer patients, find reliable indicators to monitor the course of disease, and implement effective prevention measures.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Neoplasms/complications , Neoplasms/epidemiology , SARS-CoV-2 , Age Factors , COVID-19/virology , Clinical Decision-Making , Comorbidity , Disease Management , Disease Susceptibility , Humans , Immunocompromised Host , Neoplasms/immunology , Neoplasms/therapy , Prognosis
16.
J Med Virol ; 92(11): 2758-2767, 2020 11.
Article in English | MEDLINE | ID: covidwho-599691

ABSTRACT

BACKGROUND: Since the outbreak of 2019 novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) pneumonia, thousands of patients with fever or cough were flocked into fever clinic of designated hospitals in Wuhan, China. To date, no data have ever been reported to reflect the prevalence of coronavirus disease 2019 (COVID-19) among these outpatients. Moreover, it is almost unknown to discriminate COVID-19 and nucleic acid negative patients based on clinical features in the fever clinics. METHODS: The infectious status of SARS-CoV-2 was estimated among the outpatients. The epidemiological and clinical characteristics were compared between COVID-19 and nucleic acid negative patients. RESULTS: The nucleic acid positive rate for SARS-CoV-2 in the outpatients from our fever clinic was 67·1%, while the majority of patients with COVID-19 were mild cases. The predominant initial symptom in those patients with COVID-19 was fever (78.2%), followed by cough (15.6%). Very significantly lower number of eosinophils was characterized in patients with COVID-19 as compared with that of nucleic acid negative patients. More importantly, the proportion of subjects with eosinophil counts lower than normal levels in patients with COVID-19 was much higher than that of nucleic acid negative patients. Fever combined with bilateral ground-glass opacities in computed tomography imaging and eosinophil count below the normal level are probably a valuable indicator of COVID-19 infection in those outpatients. CONCLUSIONS: Those findings may provide critical information for the regions, such as Europe and United States that are facing the same situation as Wuhan experienced, and could be valuable to prevent those nucleic acid negative patients from misdiagnosis before antibody testing.


Subject(s)
COVID-19/epidemiology , Fever/epidemiology , Fever/virology , Outpatients/statistics & numerical data , Adult , Aged , Ambulatory Care Facilities , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19 Nucleic Acid Testing , China/epidemiology , Cough/epidemiology , Eosinophils , Female , Humans , Male , Middle Aged
17.
Lancet Oncol ; 21(7): 893-903, 2020 07.
Article in English | MEDLINE | ID: covidwho-436717

ABSTRACT

BACKGROUND: COVID-19 has spread globally. Epidemiological susceptibility to COVID-19 has been reported in patients with cancer. We aimed to systematically characterise clinical features and determine risk factors of COVID-19 disease severity for patients with cancer and COVID-19. METHODS: In this multicentre, retrospective, cohort study, we included all adult patients (aged ≥18 years) with any type of malignant solid tumours and haematological malignancy who were admitted to nine hospitals in Wuhan, China, with laboratory-confirmed COVID-19 between Jan 13 and March 18, 2020. Enrolled patients were statistically matched (2:1) with patients admitted with COVID-19 who did not have cancer with propensity score on the basis of age, sex, and comorbidities. Demographic characteristics, laboratory examinations, illness severity, and clinical interventions were compared between patients with COVID-19 with or without cancer as well as between patients with cancer with non-severe or severe COVID-19. COVID-19 disease severity was defined on admission on the basis of the WHO guidelines. Univariable and multivariable logistic regression, adjusted for age, sex, comorbidities, cancer type, tumour stage, and antitumour treatments, were used to explore risk factors associated with COVID-19 disease severity. This study was registered in the Chinese Clinical Trial Register, ChiCTR2000030807. FINDINGS: Between Jan 13 and March 18, 2020, 13 077 patients with COVID-19 were admitted to the nine hospitals in Wuhan and 232 patients with cancer and 519 statistically matched patients without cancer were enrolled. Median follow-up was 29 days (IQR 22-38) in patients with cancer and 27 days (20-35) in patients without cancer. Patients with cancer were more likely to have severe COVID-19 than patients without cancer (148 [64%] of 232 vs 166 [32%] of 519; odds ratio [OR] 3·61 [95% CI 2·59-5·04]; p<0·0001). Risk factors previously reported in patients without cancer, such as older age; elevated interleukin 6, procalcitonin, and D-dimer; and reduced lymphocytes were validated in patients with cancer. We also identified advanced tumour stage (OR 2·60, 95% CI 1·05-6·43; p=0·039), elevated tumour necrosis factor α (1·22, 1·01-1·47; p=0·037), elevated N-terminal pro-B-type natriuretic peptide (1·65, 1·03-2·78; p=0·032), reduced CD4+ T cells (0·84, 0·71-0·98; p=0·031), and reduced albumin-globulin ratio (0·12, 0·02-0·77; p=0·024) as risk factors of COVID-19 severity in patients with cancer. INTERPRETATION: Patients with cancer and COVID-19 were more likely to deteriorate into severe illness than those without cancer. The risk factors identified here could be helpful for early clinical surveillance of disease progression in patients with cancer who present with COVID-19. FUNDING: China National Natural Science Foundation.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/pathology , Neoplasms/epidemiology , Neoplasms/pathology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/pathology , Aged , Betacoronavirus , COVID-19 , China/epidemiology , Cities/epidemiology , Coronavirus Infections/complications , Female , Hospitalization , Humans , Male , Middle Aged , Neoplasms/complications , Pandemics , Pneumonia, Viral/complications , Retrospective Studies , Risk Factors , SARS-CoV-2 , Severity of Illness Index
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