Geriatric risk factors for serious COVID-19 outcomes among older adults with cancer: a cohort study from the COVID-19 and Cancer Consortium.
Geriatric risk factors for serious COVID-19 outcomes among older adults with cancer: a cohort study from the COVID-19 and Cancer Consortium.
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DOI：
10.1016/s2666-7568(22)00009-5
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发表时间：
2022-03
期刊：
影响因子：
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通讯作者：
COVID-19 and Cancer Consortium
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文献类型：
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作者：
Elkrief A;Hennessy C;Kuderer NM;Rubinstein SM;Wulff-Burchfield E;Rosovsky RP;Vega-Luna K;Thompson MA;Panagiotou OA;Desai A;Rivera DR;Khaki AR;Tachiki L;Lynch RC;Stratton C;Elias R;Batist G;Kasi A;Shah DP;Bakouny Z;Cabal A;Clement J;Crowell J;Dixon B;Friese CR;Fry SL;Grover P;Gulati S;Gupta S;Hwang C;Khan H;Kim SJ;Klein EJ;Labaki C;McKay RR;Nizam A;Pennell NA;Puc M;Schmidt AL;Shahrokni A;Shaya JA;Su CT;Wall S;Williams N;Wise-Draper TM;Mishra S;Grivas P;French B;Warner JL;Wildes TM;COVID-19 and Cancer Consortium
年龄越大，SARS-CoV-2感染的结果越差，尽管老龄化的异质性导致一些老年人比其他人面临更大的风险。本研究的目的是量化一种新的老年风险指数（包括年龄、改良Charlson合并症指数和东部肿瘤协作组体能状态）与老年癌症患者COVID-19严重程度和30天死亡率的相关性。在这项队列研究中，我们招募了年龄在60岁及以上的当前或既往诊断为癌症的患者（不包括患有非侵袭性癌症和癌前或非恶性疾病的患者），以及在2020年3月17日至6月6日期间向COVID-19和癌症联盟（CCC 19）多国、多中心登记中心报告的当前或既往实验室确诊的COVID-19诊断，2021.患者也因年龄未知、数据缺失导致老年风险指标未知、数据质量不足或随访不完整导致COVID-19严重程度未知而被排除。感兴趣的暴露是CCC 19老年风险指数。主要结局为COVID-19严重程度，次要结局为30天全因死亡率;两者均在完整数据集中进行评估。通过有序和二元logistic回归模型估计校正的比值比（OR）和95% CI。5671名癌症和COVID-19患者被纳入分析。中位随访时间为56天（IQR 22-120），中位年龄为72岁（IQR 66-79）。CCC 19老年风险指数将2365例（41.7%）患者确定为标准风险，2217例（39.1%）患者为中度风险，1089例（19.2%）患者为高风险。36例（0.6%）患者因无法计算老年风险指数而被排除。与标准风险患者相比，高风险患者的COVID-19严重程度显著更高（调整后OR 7·24; 95% CI 6·20-8·45）。5671名患者中有920名（16.2%）在COVID-19诊断后30天内死亡，其中包括2365名标准风险患者中的161名（6.8%），2217名中等风险患者中的409名（18.5%）和1089名高风险患者中的350名（32.1%）。高风险患者的30天死亡率校正比值（校正OR 10.7; 95%CI 8.54 - 13.5）高于标准风险患者。CCC 19老年风险指数与COVID-19严重程度和30天死亡率密切相关。我们的CCC 19老年风险指数基于现成的临床因素，可能为临床医生提供一种易于使用的风险分层方法，以确定最有可能患上严重COVID-19和死亡的老年人。美国国立卫生研究院国家癌症研究所癌症中心。
Older age is associated with poorer outcomes of SARS-CoV-2 infection, although the heterogeneity of ageing results in some older adults being at greater risk than others. The objective of this study was to quantify the association of a novel geriatric risk index, comprising age, modified Charlson comorbidity index, and Eastern Cooperative Oncology Group performance status, with COVID-19 severity and 30-day mortality among older adults with cancer. In this cohort study, we enrolled patients aged 60 years and older with a current or previous cancer diagnosis (excluding those with non-invasive cancers and premalignant or non-malignant conditions) and a current or previous laboratory-confirmed COVID-19 diagnosis who reported to the COVID-19 and Cancer Consortium (CCC19) multinational, multicentre, registry between March 17, 2020, and June 6, 2021. Patients were also excluded for unknown age, missing data resulting in unknown geriatric risk measure, inadequate data quality, or incomplete follow-up resulting in unknown COVID-19 severity. The exposure of interest was the CCC19 geriatric risk index. The primary outcome was COVID-19 severity and the secondary outcome was 30-day all-cause mortality; both were assessed in the full dataset. Adjusted odds ratios (ORs) and 95% CIs were estimated from ordinal and binary logistic regression models. 5671 patients with cancer and COVID-19 were included in the analysis. Median follow-up time was 56 days (IQR 22–120), and median age was 72 years (IQR 66–79). The CCC19 geriatric risk index identified 2365 (41·7%) patients as standard risk, 2217 (39·1%) patients as intermediate risk, and 1089 (19·2%) as high risk. 36 (0·6%) patients were excluded due to non-calculable geriatric risk index. Compared with standard-risk patients, high-risk patients had significantly higher COVID-19 severity (adjusted OR 7·24; 95% CI 6·20–8·45). 920 (16·2%) of 5671 patients died within 30 days of a COVID-19 diagnosis, including 161 (6·8%) of 2365 standard-risk patients, 409 (18·5%) of 2217 intermediate-risk patients, and 350 (32·1%) of 1089 high-risk patients. High-risk patients had higher adjusted odds of 30-day mortality (adjusted OR 10·7; 95% CI 8·54–13·5) than standard-risk patients. The CCC19 geriatric risk index was strongly associated with COVID-19 severity and 30-day mortality. Our CCC19 geriatric risk index, based on readily available clinical factors, might provide clinicians with an easy-to-use risk stratification method to identify older adults most at risk for severe COVID-19 as well as mortality. US National Institutes of Health National Cancer Institute Cancer Center.