To determine the utility of admission laboratory markers in the assessment and prognostication of COVID‐19, a systematic review and meta‐analysis was conducted on the association between admission laboratory values in hospitalized COVID‐19 patients and subsequent disease severity and mortality. Searches were conducted in MEDLINE, Pubmed, Embase, and the WHO Global Research Database from Dec 1, 2019 to May 1, 2020 for relevant articles. A random effects meta‐analysis was used to calculate the weighted mean difference (WMD) and 95% confidence interval (95% CI) for each of 27 laboratory markers. The impact of age and sex on WMDs was estimated using meta‐regression techniques for 11 markers. In total, 64 studies met inclusion criteria. The most marked WMDs were for neutrophils (ANC) at 3.82x10 9 /L (2.76, 4.87), lymphocytes (ALC) at ‐0.34x10 9 /L (‐0.45, ‐0.23), interleukin‐6 (IL‐6) at 32.59pg/mL (23.99, 41.19), ferritin at 814.14ng/mL (551.48, 1076.81), C‐reactive protein (CRP) at 66.11mg/L (52.16, 80.06), Ddimer at 5.74mg/L (3.91, 7.58), LDH at 232.41U/L (178.31, 286.52), and high sensitivity troponin I at 90.47pg/mL (47.79, 133.14) when comparing fatal to non‐fatal cases. Similar trends were observed comparing severe to non‐severe groups. There were no statistically significant associations between age or sex and WMD for any of the markers included in the meta‐regression. The results highlight that hyperinflammation, blunted adaptive immune response, and intravascular coagulation play key roles in the pathogenesis of COVID‐19. Markers of these processes are good candidates to identify patients for early intervention and, importantly, are likely reliable regardless of age or sex in adult patients. This article is protected by copyright. All rights reserved.

Objectives Animal evidence suggests that circadian disruption may be associated with ovarian cancer, though very little epidemiologic work has been done to assess this potential association. We evaluated the association between self-reported nightshift work, a known circadian disruptor, and ovarian cancer in a population-based case-control study. Methods The study included 1,101 women with invasive epithelial ovarian cancer, 389 women with borderline epithelial ovarian tumors and 1,832 controls and was conducted in Western Washington State. Shift work data was collected as part of in-person interviews. Results Working the nightshift was associated with an increased risk of invasive (OR=1.24, 95% CI: 1.04–1.49) and borderline (OR=1.48, 95% CI: 1.15–1.90) tumors; however, we observed little evidence that risks increased with increasing cumulative duration of nightshift work, and risks were not elevated in the highest duration category (>7 nightshift work-years). Increased risks were restricted to women who were 50 years of age and older and to serous and mucinous histologies of invasive and borderline tumors. There was suggestive evidence of a decreased risk of ovarian cancer among women reporting a preference for activity during evenings rather than mornings. Conclusion We found evidence suggesting an association between shift work and ovarian cancer. This observation should be followed up in future studies incorporating detailed assessments of diurnal preference (i.e. chronotype) in addition to detailed data on shift schedules.

Introduction: Studies of the impact of hepatitis C virus (HCV), hepatitis B virus (HBV) and HIV mono and co-infections on the risk of cancer, particularly extra-hepatic cancer, have been limited and inconsistent in their findings. Methods: In the British Columbia Hepatitis Testers Cohort, we assessed the risk of colorectal, liver, and pancreatic cancers in association with HCV, HBV and HIV infection status. Using Fine and Gray adjusted proportional subdistribution hazards models, we assessed the impact of infection status on each cancer, accounting for competing mortality risk. Cancer occurrence was ascertained from the BC Cancer Registry. Results: Among 658,697 individuals tested for the occurrence of all three infections, 1407 colorectal, 1294 liver, and 489 pancreatic cancers were identified. Compared to uninfected individuals, the risk of colorectal cancer was significantly elevated among those with HCV (Hazard ration [HR] 2.99; 95% confidence interval [CI] 2.55–3.51), HBV (HR 2.47; 95% CI 1.85–3.28), and HIV mono-infection (HR 2.30; 95% CI 1.47–3.59), and HCV/HIV co-infection. The risk of liver cancer was significantly elevated among HCV and HBV mono-infected and all co-infected individuals. The risk of pancreatic cancer was significantly elevated among individuals with HCV (HR 2.79; 95% CI 2.01–3.70) and HIV mono-infection (HR 2.82; 95% CI 1.39–5.71), and HCV/HBV co-infection. Discussion/Conclusion: Compared to uninfected individuals, the risk of colorectal, pancreatic and liver cancers was elevated among those with HCV, HBV and/or HIV infection. These findings highlight the need for targeted cancer prevention and diligent clinical monitoring for hepatic and extrahepatic cancers in infected populations.

IntroductionChronic infection with hepatitis C virus (HCV) is an established risk factor for liver cancer. Although several epidemiologic studies have evaluated the risk of extrahepatic malignancies among people living with HCV, due to various study limitations, results have been heterogeneous.MethodsWe used data from the British Columbia Hepatitis Testers Cohort (BC-HTC), which includes all individuals tested for HCV in the Province since 1990. We assessed hepatic and extrahepatic cancer incidence using data from BC Cancer Registry. Standardized incidence ratios (SIR) comparing to the general population of BC were calculated for each cancer site from 1990 to 2016.ResultsIn total, 56,823 and 1,207,357 individuals tested positive and negative for HCV, respectively. Median age at cancer diagnosis among people with and without HCV infection was 59 (interquartile range (IQR): 53-65) and 63 years (IQR: 54-74), respectively. As compared to people living without HCV, a greater proportion of people living with HCV-infection were men (66.7% vs. 44.7%, P-value <0.0001), had comorbidities (25.0% vs. 16.3%, P-value <0.0001) and were socially deprived (35.9% vs. 25.0%, P-value <0.0001). The SIRs for liver (SIR 33.09; 95% CI 29.80-36.39), anal (SIR: 2.57; 95% CI 1.52-3.63), oesophagus (SIR: 2.00; 95% CI 1.17-2.82), larynx (SIR: 3.24; 95% CI 1.21-5.27), lung (SIR: 2.20; 95% CI 1.82-2.58), and oral (SIR: 1.78; 95% CI 1.33-2.23) cancers were significantly higher among individuals living with HCV. The SIRs for bile duct and pancreatic cancers were significantly elevated among both individuals living with (SIR; 95% CI: 2.20; 1.27-3.14; 2.18; 1.57-2.79, respectively) and without HCV (SIR; 95% CI: 2.12; 1.88-2.36; 1.20; 1.11-1.28, respectively).Discussion/ConclusionIn this study, HCV infection was associated with increased incidence of several extrahepatic cancers. The elevated incidence of multiple cancers among negative HCV testers highlights the potential contributions of screening bias and increased cancer risks associated with factors driving acquisition of infection among this population compared to the general population. Early HCV diagnosis and treatment as well as public health prevention strategies are needed to reduce the risk of extrahepatic cancers among people living with HCV and potentially populations who are at higher risk of HCV infection.

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