Cancer history is an independent risk factor for mortality in hospitalized COVID-19 patients: a propensity score-matched analysis

Abstract

Background: Although research on the effects of comorbidities on coronavirus disease 2019 (COVID-19) patients is increasing, the risk of cancer history has not been evaluated for the mortality of patients with COVID-19. Methods: In this retrospective study, we included 3232 patients with pathogen-confirmed COVID-19 who were hospitalized between January 18th and March 27th, 2020, at Tongji Hospital in Wuhan, China. Propensity score matching was used to minimize selection bias. Results: In total, 2665 patients with complete clinical outcomes were analyzed. The impacts of age, sex, and comorbidities were evaluated separately using binary logistic regression analysis. The results showed that age, sex, and cancer history are independent risk factors for mortality in hospitalized COVID-19 patients. COVID-19 patients with cancer exhibited a significant increase in mortality rate (29.4% vs. 10.2%, P < 0.0001). Furthermore, the clinical outcomes of patients with hematological malignancies were worse, with a mortality rate twice that of patients with solid tumors (50% vs. 26.1%). Importantly, cancer patients with complications had a significantly higher risk of poor outcomes. One hundred nine cancer patients were matched to noncancer controls in a 1:3 ratio by propensity score matching. After propensity score matching, the cancer patients still had a higher risk of mortality than the matched noncancer patients (odds ratio (OR) 2.98, 95% confidence interval (95% CI) 1.76-5.06). Additionally, elevations in ferritin, high-sensitivity C-reactive protein, erythrocyte sedimentation rate, procalcitonin, prothrombin time, interleukin-2 (IL-2) receptor, and interleukin-6 (IL-6) were observed in cancer patients.

Ferritin in the coronavirus disease 2019 (COVID‐19): A systematic review and meta‐analysis

“…A total of 777 records were collected by the databases and manual searching. After the exclusion of the duplicates, review articles, case reports, pre‐printed versions without peer‐review, and irrelevant studies by title or abstract screening, 187 studies remained for full‐text review; 52 studies 6,17‐67 were finally included into the meta‐analysis, and 18 studies were included in the qualitative synthesis (Figure 1). A total of 52 records involving 10 614 COVID‐19 patients confirmed between December 25, 2019, and June 1, 2020, were included.…”

“…The repetition of patients from the same hospital was examined during the same period. Most of the selected studies (29/52) were performed in China 6,17‐25,27‐32,35‐37,50,59‐67 . Ten studies were performed in multicenters 6,17,23,34,45,49,57,58,60,64 .…”

“…The meta‐analysis confirmed this results. Meng et al firstly investigated the ferritin levels in COVID‐19 patients with cancer, who showed significantly higher levels of ferritin compared with those without 62 . Additionally, other inflammatory markers such as CRP, erythrocyte sedimentation rate, IL‐6, and procalcitonin were also present in higher level in COVID‐19 patients with cancer, indicating a hyperinflammatory reactions in COVID‐19 patients with cancer.…”

Covid‐19 in patients with hematological and solid cancers at a Comprehensive Cancer Center in Germany

“…First reports from China indicated that cancer patients with Covid-19 may have a higher risk of a severe disease course and less favorable outcome compared to noncancer patients with Covid-19. [11][12][13][14] However, sample sizes were small and patient cohorts consisted mainly of patients with solid tumors. 11,12 Recently, two reports from China and one from the UK described larger multi-center studies on cancer patients with Covid-19.…”

COVID-19 Triage and Test Center: Safety, Feasibility, and Outcomes of Low-Threshold Testing

“…In that study, dyspnea, hemoptysis, and unconsciousness were clinical predictors of critical illness [ 23 ]. While several clinical predictors for severe COVID-19 (dyspnea [ 24 ], old age [ 25 ], type II diabetes [ 26 ], obesity [ 27 ], possibly hypertension [ 28 ], history of cancer [ 29 ], cardiovascular disease [ 30 ], or increased ratios of CD4/CD8 [ 31 ], neutrophils/lymphocytes [ 32 ], and CRP/lymphocytes [ 33 ]) have been identified, no study has assessed clinical predictors for SARS-CoV-2 positivity. This knowledge is important for the upcoming phase, when the ratio of patients affected to patients tested will remain low in most test centers.…”