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Factors Associated With COVID-19 Infection Severity in Patients With Cancer: Wuhan City Study


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In a retrospective cohort study reported in The Lancet Oncology, Tian et al identified factors associated with severity of illness in patients with cancer hospitalized for COVID-19 over a 2-month period in Wuhan.

“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.”
— Tian et al

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Study Details

The study included all patients aged ≥ 18 years with any type of solid tumor or hematologic malignancy admitted to nine hospitals in Wuhan with laboratory-confirmed COVID-19 between January 13 and March 18, 2020. For analysis of risk of severe COVID-19, patients with cancer were 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. Multivariate analyses of risk factors in the population with cancer included adjustment for age, sex, comorbidities, tumor stage, cancer type, and antitumor treatment.

Severe COVID-19 was defined as disease associated with any of the following symptoms:

  • Respiratory rate of ≥ 30 breaths per minute
  • Oxygen saturation of ≤ 93% in resting state
  • Ratio of arterial partial pressure of oxygen and oxygen concentration ≤ 300 mm Hg
  • Greater than 50% lesion progression in lung imaging within 24 to 48 hours.

Key Findings

A total of 232 patients with cancer and 519 matched patients without cancer were included in the analysis. Median follow-up was 29 days in patients with cancer and 27 days in patients without cancer.

Severe COVID-19 was identified in 64% (n = 148) of patients with cancer vs 32% (n = 166) of patients without cancer (odds ratio [OR] = 3.61, P < .0001). Among all patients, death was more common among patients with cancer (20% vs 11%, no statistical comparison).

On multivariate analysis among patients with cancer, risk factors for severe disease that previously have been identified in patients without cancer were also identified as significant risk factors in patients with cancer, including older age (OR = 1.04 , P = .034), elevated interleukin-6 (OR = 1.03, P = .019), elevated procalcitonin (OR =  2.76, P = .0015), elevated D-dimer (OR = 1.12, P  = .0074), and reduced lymphocytes (OR = 0.96, P = .020).

Additional risk factors for severe disease among patients with cancer on multivariate analysis included advanced tumor stage (OR = 2.60, P = .039), elevated tumor necrosis factor α (OR = 1.22, P = .037), elevated N-terminal pro–B-type natriuretic peptide (OR = 1.65, P = .032), reduced CD4-positive T cells (OR = 0.84, P = .031), and reduced albumin:globulin ratio (OR = 0.12, P = .024).

The investigators concluded, “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.”

Zhihua Wang, MD, of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, is the corresponding author for The Lancet Oncology article.

Disclosure: The study was funded by the China National Natural Science Foundation. For full disclosures of the study authors, visit thelancet.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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