Immunological alternation in COVID-19 patients with cancer and its implications on mortality.

ABSTRACT

Patients with malignancy were reportedly more susceptible and vulnerable to Coronavirus Disease 2019 (COVID-19), and witnessed a greater mortality risk in COVID-19 infection than noncancerous patients. But the role of immune dysregulation of malignant patients on poor prognosis of COVID-19 has remained insufficiently investigated. Here we conducted a retrospective cohort study that included 2,052 patients hospitalized with COVID-19 (Cancer, n = 93; Non-cancer, n = 1,959), and compared the immunological characteristics of both cohorts. We used stratification analysis, multivariate regressions, and propensity-score matching to evaluate the effect of immunological indices. In result, COVID-19 patients with cancer had ongoing and significantly elevated inflammatory factors and cytokines (high-sensitivity C-reactive protein, procalcitonin, interleukin (IL)-2 receptor, IL-6, IL-8), as well as decreased immune cells (CD8 + T cells, CD4 + T cells, B cells, NK cells, Th and Ts cells) than those without cancer. The mortality rate was significantly higher in cancer cohort (24.7%) than non-cancer cohort (10.8%). By stratification analysis, COVID-19 patients with immune dysregulation had poorer prognosis than those with the relatively normal immune system both in cancer and non-cancer cohort. By logistic regression, Cox regression, and propensity-score matching, we found that prior to adjustment for immunological indices, cancer history was associated with an increased mortality risk of COVID-19 (p < .05); after adjustment for immunological indices, cancer history was no longer an independent risk factor for poor prognosis of COVID-19 (p > .30). In conclusion, COVID-19 patients with cancer had more severely dysregulated immune responses than noncancerous patients, which might account for their poorer prognosis. Clinical Trial This study has been registered on the Chinese Clinical Trial Registry (No. ChiCTR2000032161).