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Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study - 03/08/20

Doi : 10.1016/S1470-2045(20)30309-0 
Jianbo Tian, PhD a, *, Xianglin Yuan, ProfMD c, *, Jun Xiao, MD d, *, Qiang Zhong, ProfMD e, *, Chunguang Yang, MD d, *, Bo Liu, MD c, *, Yimin Cai, PhD a, *, Zequn Lu, PhD a, *, Jing Wang, BS d, Yanan Wang, MD d, Shuanglin Liu, MD i, Biao Cheng, PhD j, Jin Wang, MD l, Ming Zhang, BS a, Lu Wang, BS a, Siyuan Niu, BS a, Zhi Yao, MD n, Xiongbo Deng, MD o, Fan Zhou, MD p, Wei Wei, MD q, Qinglin Li, MD r, Xin Chen, MD c, Wenqiong Chen, BS d, Qin Yang, MD f, Shiji Wu, MS g, Jiquan Fan, MD m, Bo Shu, MD k, Zhiquan Hu, MD d, Shaogang Wang, MD d, Xiang-Ping Yang, PhD b, Wenhua Liu, MPH h, Xiaoping Miao, ProfPhD a, †, Zhihua Wang, ProfMD d, †, ⁎
a Department of Epidemiology and Biostatistics, Key Laboratory for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
b Department of Immunology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
c Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
d Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
e Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
f Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
g Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
h Clinical Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
i Department of Urology, Wuhan First Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
j Department of Pharmacy, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
k Department of Urology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
l Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
m Department of Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
n Department of Respirology and Tuberculosis Specialty, Wuhan Pulmonary Hospital, Wuhan, China 
o Department of Radiology, Wuhan Jinyintan Hospital, Wuhan, China 
p Department of Urology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
q Department of Urology, The Fifth Hospital of Wuhan, Wuhan, China 
r Department of Respiratory Medicine, Wuhan Hankou Hospital, Wuhan, China 

* Correspondence to: Prof Zhihua Wang, Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China Department of Urology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430030 China
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Summary

Background

COVID-19 has spread globally. Epidemiological susceptibility to COVID-19 has been reported in patients with cancer. We aimed to systematically characterise clinical features and determine risk factors of COVID-19 disease severity for patients with cancer and COVID-19.

Methods

In this multicentre, retrospective, cohort study, we included all adult patients (aged ≥18 years) with any type of malignant solid tumours and haematological malignancy who were admitted to nine hospitals in Wuhan, China, with laboratory-confirmed COVID-19 between Jan 13 and March 18, 2020. Enrolled patients were statistically 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. Demographic characteristics, laboratory examinations, illness severity, and clinical interventions were compared between patients with COVID-19 with or without cancer as well as between patients with cancer with non-severe or severe COVID-19. COVID-19 disease severity was defined on admission on the basis of the WHO guidelines. Univariable and multivariable logistic regression, adjusted for age, sex, comorbidities, cancer type, tumour stage, and antitumour treatments, were used to explore risk factors associated with COVID-19 disease severity. This study was registered in the Chinese Clinical Trial Register, ChiCTR2000030807.

Findings

Between Jan 13 and March 18, 2020, 13 077 patients with COVID-19 were admitted to the nine hospitals in Wuhan and 232 patients with cancer and 519 statistically matched patients without cancer were enrolled. Median follow-up was 29 days (IQR 22–38) in patients with cancer and 27 days (20–35) in patients without cancer. Patients with cancer were more likely to have severe COVID-19 than patients without cancer (148 [64%] of 232 vs 166 [32%] of 519; odds ratio [OR] 3·61 [95% CI 2·59–5·04]; p<0·0001). Risk factors previously reported in patients without cancer, such as older age; elevated interleukin 6, procalcitonin, and D-dimer; and reduced lymphocytes were validated in patients with cancer. We also identified advanced tumour stage (OR 2·60, 95% CI 1·05–6·43; p=0·039), elevated tumour necrosis factor α (1·22, 1·01–1·47; p=0·037), elevated N-terminal pro-B-type natriuretic peptide (1·65, 1·03–2·78; p=0·032), reduced CD4+ T cells (0·84, 0·71–0·98; p=0·031), and reduced albumin–globulin ratio (0·12, 0·02–0·77; p=0·024) as risk factors of COVID-19 severity in patients with cancer.

Interpretation

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.

Funding

China National Natural Science Foundation.

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© 2020  Elsevier Ltd. Reservados todos los derechos.
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Vol 21 - N° 7

P. 893-903 - juillet 2020 Regresar al número
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