Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study
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. In this multicentre, retrospect...
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| Veröffentlicht in: | The lancet oncology 2020-07, Vol.21 (7), p.893-903 |
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| container_title | The lancet oncology |
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| creator | Tian, Jianbo Yuan, Xianglin Xiao, Jun Zhong, Qiang Yang, Chunguang Liu, Bo Cai, Yimin Lu, Zequn Wang, Jing Wang, Yanan Liu, Shuanglin Cheng, Biao Wang, Jin Zhang, Ming Wang, Lu Niu, Siyuan Yao, Zhi Deng, Xiongbo Zhou, Fan Wei, Wei Li, Qinglin Chen, Xin Chen, Wenqiong Yang, Qin Wu, Shiji Fan, Jiquan Shu, Bo Hu, Zhiquan Wang, Shaogang Yang, Xiang-Ping Liu, Wenhua Miao, Xiaoping Wang, Zhihua |
| description | 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.
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.
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 |
| doi_str_mv | 10.1016/S1470-2045(20)30309-0 |
| format | Article |
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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.
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.
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.
China National Natural Science Foundation.</description><identifier>ISSN: 1470-2045</identifier><identifier>ISSN: 1474-5488</identifier><identifier>EISSN: 1474-5488</identifier><identifier>DOI: 10.1016/S1470-2045(20)30309-0</identifier><identifier>PMID: 32479790</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Age ; Aged ; Betacoronavirus ; Blood cancer ; Brain natriuretic peptide ; Cancer ; Cardiovascular disease ; CD4 antigen ; China - epidemiology ; Chronic obstructive pulmonary disease ; Cities - epidemiology ; Cohort analysis ; Coronavirus Infections - complications ; Coronavirus Infections - epidemiology ; Coronavirus Infections - pathology ; Coronaviruses ; COVID-19 ; Cytokines ; Data collection ; Diabetes ; Epidemiology ; Female ; Globulins ; Hospitalization ; Hospitals ; Humans ; Hypertension ; Illnesses ; Infections ; Interleukin 6 ; Laboratories ; Lymphocytes T ; Male ; Malignancy ; Middle Aged ; Neoplasms - complications ; Neoplasms - epidemiology ; Neoplasms - pathology ; Pandemics ; Patients ; Pneumonia, Viral - complications ; Pneumonia, Viral - epidemiology ; Pneumonia, Viral - pathology ; Procalcitonin ; Retrospective Studies ; Risk Factors ; SARS-CoV-2 ; Severe acute respiratory syndrome coronavirus 2 ; Severity of Illness Index ; Solid tumors ; Studies ; Tumor necrosis factor ; Tumor necrosis factor-TNF</subject><ispartof>The lancet oncology, 2020-07, Vol.21 (7), p.893-903</ispartof><rights>2020 Elsevier Ltd</rights><rights>Copyright © 2020 Elsevier Ltd. All rights reserved.</rights><rights>2020. Elsevier Ltd</rights><rights>2020 Elsevier Ltd. All rights reserved. 2020 Elsevier Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c575t-9ded63418439f2e166e28a39721cc89eab00cf84fd4e743f1884369578aeb1c83</citedby><cites>FETCH-LOGICAL-c575t-9ded63418439f2e166e28a39721cc89eab00cf84fd4e743f1884369578aeb1c83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1470204520303090$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32479790$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tian, Jianbo</creatorcontrib><creatorcontrib>Yuan, Xianglin</creatorcontrib><creatorcontrib>Xiao, Jun</creatorcontrib><creatorcontrib>Zhong, Qiang</creatorcontrib><creatorcontrib>Yang, Chunguang</creatorcontrib><creatorcontrib>Liu, Bo</creatorcontrib><creatorcontrib>Cai, Yimin</creatorcontrib><creatorcontrib>Lu, Zequn</creatorcontrib><creatorcontrib>Wang, Jing</creatorcontrib><creatorcontrib>Wang, Yanan</creatorcontrib><creatorcontrib>Liu, Shuanglin</creatorcontrib><creatorcontrib>Cheng, Biao</creatorcontrib><creatorcontrib>Wang, Jin</creatorcontrib><creatorcontrib>Zhang, Ming</creatorcontrib><creatorcontrib>Wang, Lu</creatorcontrib><creatorcontrib>Niu, Siyuan</creatorcontrib><creatorcontrib>Yao, Zhi</creatorcontrib><creatorcontrib>Deng, Xiongbo</creatorcontrib><creatorcontrib>Zhou, Fan</creatorcontrib><creatorcontrib>Wei, Wei</creatorcontrib><creatorcontrib>Li, Qinglin</creatorcontrib><creatorcontrib>Chen, Xin</creatorcontrib><creatorcontrib>Chen, Wenqiong</creatorcontrib><creatorcontrib>Yang, Qin</creatorcontrib><creatorcontrib>Wu, Shiji</creatorcontrib><creatorcontrib>Fan, Jiquan</creatorcontrib><creatorcontrib>Shu, Bo</creatorcontrib><creatorcontrib>Hu, Zhiquan</creatorcontrib><creatorcontrib>Wang, Shaogang</creatorcontrib><creatorcontrib>Yang, Xiang-Ping</creatorcontrib><creatorcontrib>Liu, Wenhua</creatorcontrib><creatorcontrib>Miao, Xiaoping</creatorcontrib><creatorcontrib>Wang, Zhihua</creatorcontrib><title>Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study</title><title>The lancet oncology</title><addtitle>Lancet Oncol</addtitle><description>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.
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.
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.
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.
China National Natural Science Foundation.</description><subject>Age</subject><subject>Aged</subject><subject>Betacoronavirus</subject><subject>Blood cancer</subject><subject>Brain natriuretic peptide</subject><subject>Cancer</subject><subject>Cardiovascular disease</subject><subject>CD4 antigen</subject><subject>China - epidemiology</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Cities - epidemiology</subject><subject>Cohort analysis</subject><subject>Coronavirus Infections - complications</subject><subject>Coronavirus Infections - epidemiology</subject><subject>Coronavirus Infections - pathology</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>Cytokines</subject><subject>Data collection</subject><subject>Diabetes</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Globulins</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Illnesses</subject><subject>Infections</subject><subject>Interleukin 6</subject><subject>Laboratories</subject><subject>Lymphocytes T</subject><subject>Male</subject><subject>Malignancy</subject><subject>Middle Aged</subject><subject>Neoplasms - complications</subject><subject>Neoplasms - epidemiology</subject><subject>Neoplasms - pathology</subject><subject>Pandemics</subject><subject>Patients</subject><subject>Pneumonia, Viral - complications</subject><subject>Pneumonia, Viral - epidemiology</subject><subject>Pneumonia, Viral - pathology</subject><subject>Procalcitonin</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>SARS-CoV-2</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Severity of Illness Index</subject><subject>Solid tumors</subject><subject>Studies</subject><subject>Tumor necrosis factor</subject><subject>Tumor necrosis factor-TNF</subject><issn>1470-2045</issn><issn>1474-5488</issn><issn>1474-5488</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkktv1DAQgC0Eou3CTwBZ4lKkBuzEiWMOIBRelSr1wOtoee0Jccnai-1stb-Iv4mzKRVw4WB7PP7m5RmEHlHyjBLaPP9IGSdFSVh9WpKnFamIKMgddJzVrKhZ2949yAtyhE5ivCKEckrq--ioKhkXXJBj9LMbrbNajVgPKiidINiYrI5YOYOz_B33WetDVsTotVUJDL62acDd5ZfzNwUV2NgIKgKOsMvWaY-tw1uVLLgUF1QrpyHM-q_ToNwZ7gbr1Aus8GYac7RMBjjDAVLwcQs62V2-aj_4kHBMk9k_QPd6NUZ4eHOu0Od3bz91H4qLy_fn3euLQte8ToUwYJqK0ZZVoi-BNg2UraoEL6nWrQC1JkT3LesNA86qnraZbETNWwVrqttqhV4ufrfTegPmkJka5TbYjQp76ZWVf784O8hvfid5WQtBaXZweuMg-B8TxCQ3NmoYR-XAT1GWjMwx57VCT_5Br_wUXC4vU2XdsKYhPFP1Qun8NzFAf5sMJXIeBXkYBTn3OW_yMAqSZLvHf1Zya_W79xl4tQCQ_3NnIcioc880GBtyC6Tx9j8hfgFBbsYs</recordid><startdate>20200701</startdate><enddate>20200701</enddate><creator>Tian, Jianbo</creator><creator>Yuan, Xianglin</creator><creator>Xiao, Jun</creator><creator>Zhong, Qiang</creator><creator>Yang, Chunguang</creator><creator>Liu, Bo</creator><creator>Cai, Yimin</creator><creator>Lu, Zequn</creator><creator>Wang, Jing</creator><creator>Wang, Yanan</creator><creator>Liu, Shuanglin</creator><creator>Cheng, Biao</creator><creator>Wang, Jin</creator><creator>Zhang, Ming</creator><creator>Wang, Lu</creator><creator>Niu, Siyuan</creator><creator>Yao, Zhi</creator><creator>Deng, Xiongbo</creator><creator>Zhou, Fan</creator><creator>Wei, Wei</creator><creator>Li, Qinglin</creator><creator>Chen, Xin</creator><creator>Chen, Wenqiong</creator><creator>Yang, Qin</creator><creator>Wu, Shiji</creator><creator>Fan, Jiquan</creator><creator>Shu, Bo</creator><creator>Hu, Zhiquan</creator><creator>Wang, Shaogang</creator><creator>Yang, Xiang-Ping</creator><creator>Liu, Wenhua</creator><creator>Miao, Xiaoping</creator><creator>Wang, Zhihua</creator><general>Elsevier Ltd</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TZ</scope><scope>3V.</scope><scope>7RV</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8C2</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200701</creationdate><title>Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study</title><author>Tian, Jianbo ; Yuan, Xianglin ; Xiao, Jun ; Zhong, Qiang ; Yang, Chunguang ; Liu, Bo ; Cai, Yimin ; Lu, Zequn ; Wang, Jing ; Wang, Yanan ; Liu, Shuanglin ; Cheng, Biao ; Wang, Jin ; Zhang, Ming ; Wang, Lu ; Niu, Siyuan ; Yao, Zhi ; Deng, Xiongbo ; Zhou, Fan ; Wei, Wei ; Li, Qinglin ; Chen, Xin ; Chen, Wenqiong ; Yang, Qin ; Wu, Shiji ; Fan, Jiquan ; Shu, Bo ; Hu, Zhiquan ; Wang, Shaogang ; Yang, Xiang-Ping ; Liu, Wenhua ; Miao, Xiaoping ; Wang, Zhihua</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c575t-9ded63418439f2e166e28a39721cc89eab00cf84fd4e743f1884369578aeb1c83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Age</topic><topic>Aged</topic><topic>Betacoronavirus</topic><topic>Blood cancer</topic><topic>Brain natriuretic peptide</topic><topic>Cancer</topic><topic>Cardiovascular disease</topic><topic>CD4 antigen</topic><topic>China - epidemiology</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Cities - epidemiology</topic><topic>Cohort analysis</topic><topic>Coronavirus Infections - complications</topic><topic>Coronavirus Infections - epidemiology</topic><topic>Coronavirus Infections - pathology</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>Cytokines</topic><topic>Data collection</topic><topic>Diabetes</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Globulins</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Illnesses</topic><topic>Infections</topic><topic>Interleukin 6</topic><topic>Laboratories</topic><topic>Lymphocytes T</topic><topic>Male</topic><topic>Malignancy</topic><topic>Middle Aged</topic><topic>Neoplasms - complications</topic><topic>Neoplasms - epidemiology</topic><topic>Neoplasms - pathology</topic><topic>Pandemics</topic><topic>Patients</topic><topic>Pneumonia, Viral - complications</topic><topic>Pneumonia, Viral - epidemiology</topic><topic>Pneumonia, Viral - pathology</topic><topic>Procalcitonin</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>SARS-CoV-2</topic><topic>Severe acute respiratory syndrome coronavirus 2</topic><topic>Severity of Illness Index</topic><topic>Solid tumors</topic><topic>Studies</topic><topic>Tumor necrosis factor</topic><topic>Tumor necrosis factor-TNF</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tian, Jianbo</creatorcontrib><creatorcontrib>Yuan, Xianglin</creatorcontrib><creatorcontrib>Xiao, Jun</creatorcontrib><creatorcontrib>Zhong, Qiang</creatorcontrib><creatorcontrib>Yang, Chunguang</creatorcontrib><creatorcontrib>Liu, Bo</creatorcontrib><creatorcontrib>Cai, Yimin</creatorcontrib><creatorcontrib>Lu, Zequn</creatorcontrib><creatorcontrib>Wang, Jing</creatorcontrib><creatorcontrib>Wang, Yanan</creatorcontrib><creatorcontrib>Liu, Shuanglin</creatorcontrib><creatorcontrib>Cheng, Biao</creatorcontrib><creatorcontrib>Wang, Jin</creatorcontrib><creatorcontrib>Zhang, Ming</creatorcontrib><creatorcontrib>Wang, Lu</creatorcontrib><creatorcontrib>Niu, Siyuan</creatorcontrib><creatorcontrib>Yao, Zhi</creatorcontrib><creatorcontrib>Deng, Xiongbo</creatorcontrib><creatorcontrib>Zhou, Fan</creatorcontrib><creatorcontrib>Wei, Wei</creatorcontrib><creatorcontrib>Li, Qinglin</creatorcontrib><creatorcontrib>Chen, Xin</creatorcontrib><creatorcontrib>Chen, Wenqiong</creatorcontrib><creatorcontrib>Yang, Qin</creatorcontrib><creatorcontrib>Wu, Shiji</creatorcontrib><creatorcontrib>Fan, Jiquan</creatorcontrib><creatorcontrib>Shu, Bo</creatorcontrib><creatorcontrib>Hu, Zhiquan</creatorcontrib><creatorcontrib>Wang, Shaogang</creatorcontrib><creatorcontrib>Yang, Xiang-Ping</creatorcontrib><creatorcontrib>Liu, Wenhua</creatorcontrib><creatorcontrib>Miao, Xiaoping</creatorcontrib><creatorcontrib>Wang, Zhihua</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Pharma and Biotech Premium PRO</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Lancet Titles</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The lancet oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tian, Jianbo</au><au>Yuan, Xianglin</au><au>Xiao, Jun</au><au>Zhong, Qiang</au><au>Yang, Chunguang</au><au>Liu, Bo</au><au>Cai, Yimin</au><au>Lu, Zequn</au><au>Wang, Jing</au><au>Wang, Yanan</au><au>Liu, Shuanglin</au><au>Cheng, Biao</au><au>Wang, Jin</au><au>Zhang, Ming</au><au>Wang, Lu</au><au>Niu, Siyuan</au><au>Yao, Zhi</au><au>Deng, Xiongbo</au><au>Zhou, Fan</au><au>Wei, Wei</au><au>Li, Qinglin</au><au>Chen, Xin</au><au>Chen, Wenqiong</au><au>Yang, Qin</au><au>Wu, Shiji</au><au>Fan, Jiquan</au><au>Shu, Bo</au><au>Hu, Zhiquan</au><au>Wang, Shaogang</au><au>Yang, Xiang-Ping</au><au>Liu, Wenhua</au><au>Miao, Xiaoping</au><au>Wang, Zhihua</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study</atitle><jtitle>The lancet oncology</jtitle><addtitle>Lancet Oncol</addtitle><date>2020-07-01</date><risdate>2020</risdate><volume>21</volume><issue>7</issue><spage>893</spage><epage>903</epage><pages>893-903</pages><issn>1470-2045</issn><issn>1474-5488</issn><eissn>1474-5488</eissn><abstract>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.
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.
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.
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.
China National Natural Science Foundation.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>32479790</pmid><doi>10.1016/S1470-2045(20)30309-0</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1470-2045 |
| ispartof | The lancet oncology, 2020-07, Vol.21 (7), p.893-903 |
| issn | 1470-2045 1474-5488 1474-5488 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7259911 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Age Aged Betacoronavirus Blood cancer Brain natriuretic peptide Cancer Cardiovascular disease CD4 antigen China - epidemiology Chronic obstructive pulmonary disease Cities - epidemiology Cohort analysis Coronavirus Infections - complications Coronavirus Infections - epidemiology Coronavirus Infections - pathology Coronaviruses COVID-19 Cytokines Data collection Diabetes Epidemiology Female Globulins Hospitalization Hospitals Humans Hypertension Illnesses Infections Interleukin 6 Laboratories Lymphocytes T Male Malignancy Middle Aged Neoplasms - complications Neoplasms - epidemiology Neoplasms - pathology Pandemics Patients Pneumonia, Viral - complications Pneumonia, Viral - epidemiology Pneumonia, Viral - pathology Procalcitonin Retrospective Studies Risk Factors SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Severity of Illness Index Solid tumors Studies Tumor necrosis factor Tumor necrosis factor-TNF |
| title | Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study |
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