Preinfection laboratory parameters may predict COVID‐19 severity in tumor patients

Abstract

Background Infection with SARS‐CoV‐2 leads to COVID‐19, the course of which is highly variable and depends on numerous patient‐specific risk factors. Patients with tumor diseases are considered to be more susceptible to severe COVID‐19; however, they also represent a heterogeneous group of individuals with variable risk. Identifying specific risk factors for a severe course of COVID‐19 in patients with cancer is of great importance. Methods Patients diagnosed with solid tumors or hematological malignancies and PCR‐confirmed SARS‐CoV‐2 infection were included into the multicentric ADHOK (Arbeitsgemeinschaft der Hämatologen und Onkologen im Krankenhaus e.V.) coronavirus tumor registry. Detailed information about the patients’ cancer disease, treatment, and laboratory parameters prior to infection, was collected retrospectively. The outcome of the SARS‐CoV‐2 infection was graded according to the WHO. Results A total of 195 patients (68% with solid neoplasms and 32% with hematological malignancies) were included in the registry. Overall, the course of the SARS‐CoV‐2 infection varied greatly, as 69% of all patients were either asymptomatic or encountered a mild to moderate course, while 23% of the cohort died from COVID‐19. In multivariable analysis, preinfection laboratory parameters (determined at least 10 days and a median of 21 days before the first documentation of SARS‐CoV‐2 infection) significantly correlated with severe course of the disease. Out of these, the absolute neutrophil count prior to infection showed the strongest association with COVID‐19‐related death. Conclusion The course of COVID‐19 in patients with tumor diseases is highly variable. Preinfection laboratory parameters may aid to identify patients at risk for severe COVID‐19 at an early stage prior to infection with the virus. German Clinical Trials Register identification: DRKS00023012.

Reduced Absolute Count of Monocytes in Patients Carrying Hematological Neoplasms and SARS-CoV2 Infection

“…In our series we could not find any correlation between clinical severity or overall survival after COVID-19 associated to changes in absolute counts of neutrophils. Differently from data obtained from the general population or in cancer patients, the pre-infection absolute count of neutrophils and lymphocytes, C-RP and LDH were not associated to OS in unvaccinated patients included in our series [ 36 , 46 ]. However, C-RP and LDH were higher in those patients who did not achieve viral clearance by 14 days, reflecting the impairment of the inflammatory status in COVID-19 [ 50 ].…”

“…There were no significant differences in pre-infection laboratory parameters evaluated among unvaccinated and fully vaccinated patients, including absolute counts of neutrophils, monocytes and lymphocytes, C-reactive protein (C-RP) and lactate de-hydrogenase, which have been associated with COVID-19 severity in both general population and cancer subjects [ 36 , 37 ].…”

Neutrophil Functional Heterogeneity and Implications for Viral Infections and Treatments

“…These results are enhanced by the knowledge that neutrophilia has been described as an indicator of severe respiratory symptoms and a poor outcome in the novel coronavirus disease that was first identified in 2019 (COVID-19) [149][150][151][152]. It has been observed that neutrophil count in the circulation was the greatest independent prognostic indicator for COVID-19 mortality [153], highlighting the importance of neutrophils in viral infections and the prognostic potential for neutrophils in COVID-19, which also has implications for treatment courses.…”