Immunological alternation in COVID-19 patients with cancer and its implications on mortality.
Immunological alternation in COVID-19 patients with cancer and its implications on mortality.
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COVID-19 癌症患者的免疫学改变及其对死亡率的影响
DOI：
10.1080/2162402x.2020.1854424
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发表时间：
2021-01-04
期刊：
影响因子：
7.2
通讯作者：
Gao Q
中科院分区：
文献类型：
--
作者：
Cai G;Gao Y;Zeng S;Yu Y;Liu X;Liu D;Wang Y;Yu R;Desai A;Li C;Gao Q
摘要据报道，恶性肿瘤患者更容易感染2019冠状病毒病（COVID-19），并且与非癌症患者相比，COVID-19感染的死亡风险更大。但是，恶性肿瘤患者的免疫失调对COVID-19预后不良的作用仍然没有得到充分的研究。在这里，我们进行了一项回顾性队列研究，包括2,052名因COVID-19住院的患者（癌症，n = 93;非癌症，n = 1,959），并比较了两个队列的免疫学特征。我们使用分层分析、多元回归分析和倾向评分匹配来评估免疫指标的作用。结果，与未患癌症的患者相比，COVID-19癌症患者的炎症因子和细胞因子（高敏C反应蛋白、降钙素原、白细胞介素（IL）-2受体、IL-6、IL-8）持续且显著升高，免疫细胞（CD 8 + T细胞、CD 4 + T细胞、B细胞、NK细胞、Th和Ts细胞）减少。癌症组的死亡率（24.7%）显著高于非癌症组（10.8%）。分层分析显示，无论是癌症还是非癌症队列，免疫功能异常的COVID-19患者的预后均比免疫系统相对正常的患者差。通过logistic回归、考克斯回归和倾向评分匹配，我们发现在调整免疫学指标之前，癌症史与COVID-19死亡风险增加相关（p < .05）;调整免疫学指标之后，癌症史不再是COVID-19预后不良的独立风险因素（p > .30）。总之，COVID-19癌症患者的免疫反应失调比非癌症患者更严重，这可能是他们预后较差的原因。临床试验：本研究已在中国临床试验注册中心注册（注册号：ChiCTR 2000032161）。
ABSTRACT Patients with malignancy were reportedly more susceptible and vulnerable to Coronavirus Disease 2019 (COVID-19), and witnessed a greater mortality risk in COVID-19 infection than noncancerous patients. But the role of immune dysregulation of malignant patients on poor prognosis of COVID-19 has remained insufficiently investigated. Here we conducted a retrospective cohort study that included 2,052 patients hospitalized with COVID-19 (Cancer, n = 93; Non-cancer, n = 1,959), and compared the immunological characteristics of both cohorts. We used stratification analysis, multivariate regressions, and propensity-score matching to evaluate the effect of immunological indices. In result, COVID-19 patients with cancer had ongoing and significantly elevated inflammatory factors and cytokines (high-sensitivity C-reactive protein, procalcitonin, interleukin (IL)-2 receptor, IL-6, IL-8), as well as decreased immune cells (CD8 + T cells, CD4 + T cells, B cells, NK cells, Th and Ts cells) than those without cancer. The mortality rate was significantly higher in cancer cohort (24.7%) than non-cancer cohort (10.8%). By stratification analysis, COVID-19 patients with immune dysregulation had poorer prognosis than those with the relatively normal immune system both in cancer and non-cancer cohort. By logistic regression, Cox regression, and propensity-score matching, we found that prior to adjustment for immunological indices, cancer history was associated with an increased mortality risk of COVID-19 (p < .05); after adjustment for immunological indices, cancer history was no longer an independent risk factor for poor prognosis of COVID-19 (p > .30). In conclusion, COVID-19 patients with cancer had more severely dysregulated immune responses than noncancerous patients, which might account for their poorer prognosis. Clinical Trial: This study has been registered on the Chinese Clinical Trial Registry (No. ChiCTR2000032161).