High mortality among hospital-acquired COVID-19 infection in patients with cancer: A multicentre observational cohort study
High mortality among hospital-acquired COVID-19 infection in patients with cancer: A multicentre observational cohort study
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DOI：
10.1016/j.ejca.2020.08.017
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发表时间：
2020-11-01
影响因子：
8.4
通讯作者：
Routy, Bertrand
中科院分区：
文献类型：
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作者：
Elkrief, Arielle;Desilets, Antoine;Routy, Bertrand
研究表明，癌症患者更有可能经历COVID-19的严重后果。因此，癌症中心已作出努力，在无covid - 19病房照顾癌症患者。然而，COVID-19在癌症患者中医院传播的频率和相关性仍然未知。本研究的目的是确定医院获得性COVID-19在该人群中的发病率和影响，并确定癌症患者中COVID-19严重程度的预测因素。方法：利用加拿大魁北克省和不列颠哥伦比亚省2020年3月3日至5月23日期间的省级登记处和医院数据库，前瞻性地识别出实验室确诊的2019冠状病毒病癌症患者。收集患者的基线特征，包括年龄、性别、合并症、癌症类型和抗癌治疗类型。感兴趣的暴露为因与covid无关的原因入院后5天诊断为SARS-CoV-2的医院获得性感染发生率。共同主要结局是死亡或COVID-19重症的复合结局，如住院、补充氧气、重症监护病房（ICU）入住和/或机械通气。结果：共发现新冠肺炎合并癌症患者252例（成人249例，儿童3例），其中多数为魁北克省居民（N = 233）。106例患者（42.1%）在新冠肺炎确诊前3个月内接受了积极的抗癌治疗。在中位随访25天期间，33例（13.1%）需要入院ICU， 71例（28.2%）死亡。47人（19.1%）被诊断为医院获得性COVID-19。医院获得性感染患者的中位总生存期短于当代社区获得性人群（27天vs未感染），风险比(HR) = 2.3, 95% CI: 1.2-4.4, p = 0.0006。多因素分析显示，医院获得性COVID-19、年龄、东部肿瘤合作组状态和癌症晚期与死亡独立相关。解释：我们的研究表明，在癌症人群中，COVID-19的医院传播率很高，与单因素和多因素分析的死亡率增加有关，这加强了在无COVID-19单位治疗癌症患者的重要性。我们还验证了年龄和晚期癌症是癌症患者COVID-19严重程度的负面预测因素。(C) 2020 Elsevier Ltd.版权所有。
Introduction: Studies suggest that patients with cancer are more likely to experience severe outcomes from COVID-19. Therefore, cancer centres have undertaken efforts to care for patients with cancer in COVID-free units. Nevertheless, the frequency and relevance of nosocomial transmission of COVID-19 in patients with cancer remain unknown. The goal of this study was to determine the incidence and impact of hospital-acquired COVID-19 in this population and identify predictive factors for COVID-19 severity in patients with cancer.Methods: Patients with cancer and a laboratory-confirmed diagnosis of COVID-19 were prospectively identified using provincial registries and hospital databases between March 3rd and May 23rd, 2020 in the provinces of Quebec and British Columbia in Canada. Patient's baseline characteristics including age, sex, comorbidities, cancer type and type of anticancer treatment were collected. The exposure of interest was incidence of hospital-acquired infection defined by diagnosis of SARS-CoV-2 >= 5 days after hospital admission for COVID-unrelated cause. Co-primary outcomes were death or composite outcomes of severe illness from COVID-19 such as hospitalisation, supplemental oxygen, intensive-care unit (ICU) admission and/or mechanical ventilation.Results: A total of 252 patients (N = 249 adult and N = 3 paediatric) with COVID-19 and cancer were identified, and the majority were residents of Quebec (N = 233). One hundred and six patients (42.1%) received active anticancer treatment in the last 3 months before COVID-19 diagnosis. During a median follow-up of 25 days, 33 (13.1%) required admission to the ICU, and 71 (28.2%) died. Forty-seven (19.1%) had a diagnosis of hospital-acquired COVID-19. Median overall survival was shorter in those with hospital-acquired infection than that in a contemporary community-acquired population (27 days versus unreached, hazard ratio (HR) = 2.3, 95% CI: 1.2-4.4, p = 0.0006. Multivariate analysis demonstrated that hospital-acquired COVID-19, age, Eastern Cooperative Oncology Group status and advanced stage of cancer were independently associated with death.Interpretation: Our study demonstrates a high rate of nosocomial transmission of COVID-19, associated with increased mortality in both univariate and multivariate analysis in the cancer population, reinforcing the importance of treating patients with cancer in COVID-free units. We also validated that age and advanced cancer were negative predictive factors for COVID-19 severity in patients with cancer. (C) 2020 Elsevier Ltd. All rights reserved.