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1.
Cancer Med ; 10(21): 7781-7792, 2021 11.
Article in English | MEDLINE | ID: covidwho-1432369

ABSTRACT

BACKGROUND: It is well established that cancer patients infected with SARS-CoV-2 are at particularly elevated risk of adverse outcomes, but the comparison of SARS-CoV-2 infection risk between cancer patients and cancer-free individuals has been poorly investigated on a population-basis. METHODS: A population-based study was thus conducted in Friuli Venezia Giulia region, northeastern Italy, to estimate prevalence and determinants of SARS-CoV-2 infection among cancer patients, as compared to cancer-free individuals, and to evaluate adverse outcomes of SARS-CoV-2 infection. The study included 263,042 individuals tested for SARS-CoV-2 in February-December 2020 with cancer history retrieved through the regional cancer registry. Odds ratios (ORs) of SARS-CoV-2 positivity, with corresponding 95% confidence intervals (CIs), were calculated using multivariable logistic regression models, adjusted for sex and age. Hazard ratios (HRs) adjusted for sex and age for intensive care unit (ICU) admission and all-cause death were estimated using Cox models. RESULTS: Among 26,394 cancer patients tested for SARS-CoV-2, the prevalence of infection was 11.7% versus 16.2% among 236,648 cancer-free individuals, with a corresponding OR = 0.59 (95% CI: 0.57-0.62). The prevalence was much higher (29% in both groups) during the second pandemic wave (October-December 2020). Among cancer patients, age ≥80 years and cancer diagnosis ≥13 months before SARS-CoV-2 testing were the major risk factors of infection. Among 3098 infected cancer patients, the fatality rate was 17.4% versus 15.8% among 23,296 negative ones (HR = 1.63, 95% CI: 1.49-1.78), and versus 5.0% among 38,268 infected cancer-free individuals (HR = 1.23, 95% CI: 1.12-1.36). No significant differences emerged when considering ICU admission risk. CONCLUSION: Albeit cancer patients reported reduced SARS-CoV-2 infection risk, those infected showed higher mortality than uninfected ones and infected cancer-free population. Study findings claim for continuing to protect cancer patients from SARS-CoV-2, without reducing the level of oncologic care.


Subject(s)
COVID-19/epidemiology , Neoplasms/virology , Aged , Aged, 80 and over , COVID-19/mortality , Female , Humans , Intensive Care Units/statistics & numerical data , Italy/epidemiology , Male , Middle Aged , Mortality , Neoplasms/epidemiology , Prevalence , Retrospective Studies
3.
Open Forum Infect Dis ; 7(10): ofaa421, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-756944

ABSTRACT

BACKGROUND: In hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia, progression to acute respiratory failure requiring invasive mechanical ventilation (MV) is associated with significant morbidity and mortality. Severe dysregulated systemic inflammation is the putative mechanism. We hypothesize that early prolonged methylprednisolone (MP) treatment could accelerate disease resolution, decreasing the need for intensive care unit (ICU) admission and mortality. METHODS: We conducted a multicenter observational study to explore the association between exposure to prolonged, low-dose MP treatment and need for ICU referral, intubation, or death within 28 days (composite primary end point) in patients with severe COVID-19 pneumonia admitted to Italian respiratory high-dependency units. Secondary outcomes were invasive MV-free days and changes in C-reactive protein (CRP) levels. RESULTS: Findings are reported as MP (n = 83) vs control (n = 90). The composite primary end point was met by 19 vs 40 (adjusted hazard ratio [aHR], 0.41; 95% CI, 0.24-0.72). Transfer to ICU and invasive MV were necessary in 15 vs 27 (P = .07) and 14 vs 26 (P = .10), respectively. By day 28, the MP group had fewer deaths (6 vs 21; aHR, 0.29; 95% CI, 0.12-0.73) and more days off invasive MV (24.0 ±â€…9.0 vs 17.5 ±â€…12.8; P = .001). Study treatment was associated with rapid improvement in PaO2:FiO2 and CRP levels. The complication rate was similar for the 2 groups (P = .84). CONCLUSION: In patients with severe COVID-19 pneumonia, early administration of prolonged MP treatment was associated with a significantly lower hazard of death (71%) and decreased ventilator dependence. Treatment was safe and did not impact viral clearance. A large randomized controlled trial (RECOVERY trial) has been performed that validates these findings. Clinical trial registration. ClinicalTrials.gov NCT04323592.

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