Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome

Autor: P. Huddar, A. Angelakas, Michelle Harrison, G. Brearton, Umair T Khan, S. Khan, T. Robinson, C. Wilson, Oskar Wysocki, K. Banfill, Alec Maynard, C. Hague, Daniel H. Palmer, Mark Baxter, Tim Cooksley, Anne Thomas, J. Tweedy, Carlo Palmieri, André Freitas, C. Dive, H. Boyce, Simon G. Williams, C. Zhou, Anne C Armstrong, Alexander J. Stockdale, T. Aung, Z. Hudson, Ellen Copson, L. Eastlake, M. Rowe, E. Dickens, F. Gomes, T. Bhogal, Jamie M Weaver, L. Horsley, A. Tivey, Rebecca Lee, Rohan Shotton, H. McKenzie, R. Sheehan
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Cancer Research
medicine.medical_specialty
neutrophils/metabolism
Lymphocyte
COVID-19/prevention & control
neoplasms/blood
Logistic regression
chemistry.chemical_compound
C-Reactive Protein/analysis
male
Internal medicine
Lactate dehydrogenase
L-Lactate Dehydrogenase/metabolism
middle aged
medicine
cancer
longitudinal studies
humans
lymphocyte count
Original Research
Aged
80 and over
Manchester Cancer Research Centre
business.industry
SARS-CoV-2
SARS-CoV-2/isolation & purification
adult
ResearchInstitutes_Networks_Beacons/mcrc
Albumin
Cancer
COVID-19
Outcome Assessment
Health Care/methods
platelet count
medicine.disease
United Kingdom
Exact test
aged
medicine.anatomical_structure
female
Oncology
chemistry
Cohort
Mann–Whitney U test
young adult
lymphocytes/metabolism
business
logistic models
Zdroj: Lee, R J, Wysocki, O, Bhogal, T, Shotton, R, Tivey, A, Angelakas, A, Aung, T, Banfill, K, Baxter, M, Boyce, H, Brearton, G, Copson, E, Dickens, E, Eastlake, L, Gomes, F, Hague, C, Harrison, M, Horsley, L, Huddar, P, Hudson, Z, Khan, S, Khan, U T, Maynard, A, Mckenzie, H, Palmer, D, Robinson, T, Rowe, M, Thomas, A, Tweedy, J, Sheehan, R, Stockdale, A, Weaver, J, Williams, S, Wilson, C, Zhou, C, Dive, C, Cooksley, T, Palmieri, C, Freitas, A & Armstrong, C A 2021, ' Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome ', ESMO Open, vol. 6, no. 1, 100005, pp. 1-12 . https://doi.org/10.1016/j.esmoop.2020.100005
ESMO Open
Lee, RJ, Wysocki, O, Bhogal, T, Shotton, R, Tivey, A, Angelakas, A, Aung, T, Banfill, K, Baxter, M, Boyce, H, Brearton, G, Copson, E, Dickens, E, Eastlake, L, dummy-AUTHOR_name & Armstrong, AC 2020, ' Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome. ', ESMO Open, vol. 6, no. 1, 100005, pp. 100005 . https://doi.org/10.1016/j.esmoop.2020.100005
ESMO OPEN
ISSN: 2059-7029
DOI: 10.1016/j.esmoop.2020.100005
Popis: Background Cancer patients are at increased risk of death from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer and its treatment affect many haematological and biochemical parameters, therefore we analysed these prior to and during coronavirus disease 2019 (COVID-19) and correlated them with outcome. Patients and methods Consecutive patients with cancer testing positive for SARS-CoV-2 in centres throughout the United Kingdom were identified and entered into a database following local governance approval. Clinical and longitudinal laboratory data were extracted from patient records. Data were analysed using Mann–Whitney U test, Fisher's exact test, Wilcoxon signed rank test, logistic regression, or linear regression for outcomes. Hierarchical clustering of heatmaps was performed using Ward's method. Results In total, 302 patients were included in three cohorts: Manchester (n = 67), Liverpool (n = 62), and UK (n = 173). In the entire cohort (N = 302), median age was 69 (range 19-93 years), including 163 males and 139 females; of these, 216 were diagnosed with a solid tumour and 86 with a haematological cancer. Preinfection lymphopaenia, neutropaenia and lactate dehydrogenase (LDH) were not associated with oxygen requirement (O2) or death. Lymphocyte count (P < 0.001), platelet count (P = 0.03), LDH (P < 0.0001) and albumin (P < 0.0001) significantly changed from preinfection to during infection. High rather than low neutrophils at day 0 (P = 0.007), higher maximal neutrophils during COVID-19 (P = 0.026) and higher neutrophil-to-lymphocyte ratio (NLR; P = 0.01) were associated with death. In multivariable analysis, age (P = 0.002), haematological cancer (P = 0.034), C-reactive protein (P = 0.004), NLR (P = 0.036) and albumin (P = 0.02) at day 0 were significant predictors of death. In the Manchester/Liverpool cohort 30 patients have restarted therapy following COVID-19, with no additional complications requiring readmission. Conclusion Preinfection biochemical/haematological parameters were not associated with worse outcome in cancer patients. Restarting treatment following COVID-19 was not associated with additional complications. Neutropaenia due to cancer/treatment is not associated with COVID-19 mortality. Cancer therapy, particularly in patients with solid tumours, need not be delayed or omitted due to concerns that treatment itself increases COVID-19 severity.
Highlights • Pre-infection haematological/biochemical characteristics are not associated with COVID-19 severity. • Significant haematological/biochemical changes occur upon infection with heterogeneity in response observed. • High not low neutrophils were associated with oxygen requirement and COVID-19 mortality – GCSF should be used with caution. Age, haematological cancer, high neutrophil:lymphocyte ratio, CRP and low albumin were significant predictors of death in multivariable analysis. No significant complications requiring readmission were seen upon restart of cancer therapy following diagnosis of COVID-19.
Databáze: OpenAIRE
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