COVID-19 cancer patients outcomes in an intensive care setting: A case-control study

ABSTRACT

Background: Cancer patients appear to be a vulnerable group in COVID-19 pandemic. We aimed to compare clinical characteristics and outcomes of cancer and non-cancer patients with COVID-19 admitted to an intensive care unit (ICU). Methods: We conducted a retrospective case-control study in patients with laboratory-confirmed COVID-19, with and without cancer, admitted to the ICU of “Centro Hospitalar Universitário do Porto” from 2nd March 2020 to 31st January 2021. Patients were matched according to age, gender and underlying comorbidities. Clinical, laboratory and radiological findings were obtained from medical records. COVID-19 related outcomes of both groups were compared using logistic regression. Results: 29 critical COVID-19 cancer patients (cases) and 29 critical COVID-19 non-cancer patients (controls) were enrolled. Fever, dyspnea and cough were the most common presenting symptoms in both groups. Lymphopenia and elevated lactate dehydrogenase were the most common laboratory findings in both groups and anemia was observed significantly more often in cancer patients (75.9% vs 44.8%;p=0.031). Ground glass opacities were more frequently seen in controls (100% vs 67%;p=0.018). Univariate regression revealed that invasive mechanical ventilation (IMV) need on ICU admission was significantly higher among cancer patients [48% vs 7%;odds ratio (OR)= 12.600, 95% confidence interval (CI) 2.517-63.063, p=0.002] but there was no significant impact either on global need of IMV during all-length ICU stay (76% vs 55%;OR= 2.554, 95% CI 0.831-7.842, p=0.102) or on mortality rates (59% vs 38%;OR= 2.318, 95% CI 0.809-6.644, p=0.118). A multivariate model showed an increase in the adjusted risk of IMV need at ICU admission (adjusted OR= 14.036, 95% CI 1.337-153.111, p=0.028). The length of ICU stay, time to death and rate of complications were not impacted by the presence of cancer. Conclusions: In this study critical cancer patients with COVID-19 had an increased risk for IMV need at ICU admission but not for IMV need during all-length ICU stay or mortality rates. Despite evolving more rapidly to respiratory failure (RF) cancer patients did not have significant increase on mortality, stressing the importance of aggressive treatment in this group of patients. Legal entity responsible for the study The authors. Funding: Has not received any funding. Disclosure All authors have declared no conflicts of interest.