Clinical Outcomes in Patients With COVID-19 and Hematologic Disease.

Autor: Aleshina OA; National Medical Research Center for Hematology, Moscow, Russia. Electronic address: dr.gavrilina@mail.ru., Zakurdaeva K; RakFond, Moscow, Russia., Vasileva AN; National Medical Research Center for Hematology, Moscow, Russia., Dubov SK; Regional Clinical Hospital #2, Vladivostok, Russia., Dubov VS; Regional Clinical Hospital #2, Vladivostok, Russia., Vorobyev VI; Regional Clinical Hospital, Saint-Petersburg, Russia., Butaev LS; S.P. Botkin City Clinical Hospital, Moscow, Russia., Sukhareva AM; S.P. Botkin City Clinical Hospital, Moscow, Russia., Gavrilova LV; Republican Clinical Hospital #4, Saransk, Russia., Toropova IY; Regional Clinical Hospital, Yaroslavl, Russia., Popova MO; R.M. Gorbacheva Research Institute, Pavlov University, Saint-Petersburg, Russia., Siniaev AA; R.M. Gorbacheva Research Institute, Pavlov University, Saint-Petersburg, Russia., Kulagin AD; R.M. Gorbacheva Research Institute, Pavlov University, Saint-Petersburg, Russia., Kaplanov KD; S.P. Botkin City Clinical Hospital, Moscow, Russia., Petrenko AA; S.P. Botkin City Clinical Hospital, Moscow, Russia., Ochirova OI; N.A. Semashko Republican Clinical Hospital, Ulan-Ude, Russia., Karpova A; N.A. Semashko Republican Clinical Hospital, Ulan-Ude, Russia., Chelysheva EY; National Medical Research Center for Hematology, Moscow, Russia., Turkina AG; National Medical Research Center for Hematology, Moscow, Russia., Gurianova MA; National Medical Research Center for Hematology, Moscow, Russia., Al-Radi LS; National Medical Research Center for Hematology, Moscow, Russia., Gilyazitdinova EA; National Medical Research Center for Hematology, Moscow, Russia., Egorova EK; National Medical Research Center for Hematology, Moscow, Russia., Chabaeva YA; National Medical Research Center for Hematology, Moscow, Russia., Kulikov SM; National Medical Research Center for Hematology, Moscow, Russia., Sveshnikova YV; Regional Clinical Hospital, Yekaterinburg, Russia., Kunst MA; Republican Clinical Hospital of Tatarstan, Kazan, Russia., Shuvaev V; Research Institute of Hematology and Transfusiology, Saint-Petersburg, Russia., Rakhmani AF; S.P. Botkin City Clinical Hospital, Moscow, Russia., Panteleeva OL; Regional Clinical Hospital, Vladimir, Russia., Grishunina ME; N.A. Semashko Regional Clinical Hospital, Nizhniy Novgorod, Russia., Samoylova OS; N.A. Semashko Regional Clinical Hospital, Nizhniy Novgorod, Russia., Vorontsova E; Regional Clinical Hospital, Novosibirsk, Russia., Baryshnikova DV; Regional Clinical Hospital, Omsk, Russia., Parovichnikova EN; National Medical Research Center for Hematology, Moscow, Russia.
Jazyk: angličtina
Zdroj: Clinical lymphoma, myeloma & leukemia [Clin Lymphoma Myeloma Leuk] 2023 Aug; Vol. 23 (8), pp. 589-598. Date of Electronic Publication: 2023 Apr 14.
DOI: 10.1016/j.clml.2023.04.002
Abstrakt: Background: Patients with hematologic diseases are at higher risk of the SARS-CoV-2 infection and more severe clinical outcomes of the coronavirus disease. CHRONOS19 is an observational prospective cohort study with the aim to determine the short and longer-term clinical outcomes, risk factors for disease severity and mortality, and rates of postinfectious immunity in patients with malignant and nonmalignant hematologic diseases and COVID-19.
Patients and Methods: Overall, 666 patients were enrolled in the study, of which 626 were included in the final data analysis. The primary endpoint was 30-days all-cause mortality. Secondary endpoints included COVID-19 complications, rates of ICU admission and mechanical ventilation, outcomes of a hematologic disease in SARS-CoV-2 infected patients, overall survival, and risk factors for disease severity and mortality. Data from 15 centers were collected at 30, 90, and 180 days after COVID-19 was diagnosed and were managed using a web-based e-data capture platform. All evaluations were performed in the pre-omicron period of COVID-19 pandemic.
Results: Thirty-days all-cause mortality was 18.9%. The predominant cause of death (in 80% of cases) were COVID-19 complications. At 180 days, the majority (70%) of additional deaths were due to hematologic disease progression. At a median follow-up of 5.7 [0.03-19.04] months, 6-months overall survival was 72% [95% CI: 0.69-0.76]. One-third of patients had severe SARS-CoV-2 disease. The rate of ICU admission was 22% with 77% of these patients requiring mechanical ventilation, with poor survival rate. A univariate analysis revealed that older age (≥ 60 years), male sex, malignant hematologic disease, myelotoxic agranulocytosis, transfusion dependence, refractory disease or relapse, diabetes among comorbidities, any complications, especially ARDS alone or in combination with CRS, admission to an ICU, and mechanical ventilation were associated with higher risks of mortality. Treatment of the hematologic disease was changed, postponed, or canceled in 63% of patients. At a longer follow-up (90 and 180 days), the status of the hematologic disease changed in 7.5% of patients.
Conclusion: Patients with hematologic disease and COVID-19 have high mortality rates, predominantly due to COVID-19 complications. At a longer-term follow-up, no significant impact of COVID-19 on the course of a hematologic disease was revealed.
Competing Interests: Disclosure The authors declare no competing financial interests. There was no funding used for this study or preparation of this manuscript. This article has not been published elsewhere, and is not currently under consideration for publication elsewhere.
(Copyright © 2023. Published by Elsevier Inc.)
Databáze: MEDLINE
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