Clinical characteristics and risk factors for mortality in hematologic patients affected By COVID-19
Clinical characteristics and risk factors for mortality in hematologic patients affected By COVID-19
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DOI：
10.1002/cncr.33160
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发表时间：
2020-09-10
期刊：
影响因子：
6.2
通讯作者：
Rossi, Giuseppe
中科院分区：
文献类型：
--
作者：
Cattaneo, Chiara;Daffini, Rosa;Rossi, Giuseppe
背景癌症患者被认为极易受到最近2019冠状病毒病（COVID-19）大流行的影响。然而，关于血液病患者发生COVID-19的数据仍然很少。方法对2020年3月期间在位于意大利伦巴第大区的2个血液科就诊的102名有COVID-19症状和鼻咽拭子SARS冠状病毒2阳性的患者进行研究。通过比较2019年在同一机构管理的COVID-19患者和标准血液学人群，分析了获得COVID-19的风险因素。将30天生存率与匹配的未感染对照患者（患有类似血液学疾病）和受COVID-19影响的非血液学患者的生存率进行比较。结果COVID-19患者中男性的患病率明显高于女性。感染发生在所有不同类型的血液病中;然而，慢性骨髓增生性肿瘤（包括慢性髓性白血病）患者获得COVID-19感染的风险较低，而接受免疫抑制相关治疗的免疫介导性贫血患者则较高。30天死亡率为39.2%，高于COVID-19非血液病患者（23.5%;P = 0.02）和未感染血液病对照（3%;P <0.001）。呼吸综合征的严重程度和积极的血液学治疗与预后不良独立相关。诊断和疾病状态均不影响预后。积极接受血液学治疗的患者和在COVID-19出现时患有更严重呼吸综合征的患者的预后最差。结论在COVID-19大流行期间，应建议患者在出现呼吸困难和/或呼吸道感染的最早体征时就医。医生应进行风险效益分析，以确定暂时推迟非救生治疗的影响与COVID-19相关的不良后果风险。2019冠状病毒病（COVID-19）感染发生在所有不同类型的血液病中;然而，慢性骨髓增生性肿瘤（包括慢性髓性白血病）患者获得它的风险较低，而接受免疫抑制治疗的免疫介导性贫血患者的风险较高。30天死亡率为39.2%，远高于未感染血液学对照组（3%;P <0.001）和非血液学COVID-19患者（23.5%;P = 0.02）的死亡率，尽管年龄、性别、合并症和疾病严重程度相匹配。与预后不良独立相关的变量是呼吸综合征的严重程度和任何类型的积极血液学治疗。诊断和疾病状态均不影响预后。
Background Patients with cancer are considered highly vulnerable to the recent coronavirus disease 2019 (COVID-19) pandemic. However, there are still few data on COVID-19 occurring in hematologic patients. Methods One hundred two patients with COVID-19 symptoms and a nasopharyngeal swab positive for severe acute respiratory syndrome coronavirus 2 seen at 2 hematologic departments located in Lombardy, Italy, during March 2020 were studied. Risk factors for acquiring COVID-19 were analyzed by comparisons of patients with COVID-19 and the standard hematologic population managed at the same institutions in 2019. Thirty-day survival was compared with the survival of matched uninfected control patients with similar hematologic disorders and nonhematologic patients affected by COVID-19. Results Male sex was significantly more prevalent in patients with COVID-19. The infection occurred across all different types of hematologic disease; however, the risk of acquiring a COVID-19 infection was lower for patients with chronic myeloproliferative neoplasms, including chronic myeloid leukemia, and higher for patients with immune-mediated anemia on immunosuppressive-related treatments. The 30-day mortality rate was 39.2%, which was higher than the rates for nonhematologic patients with COVID-19 (23.5%;P = .02) and uninfected hematologic controls (3%;P < .001). The severity of the respiratory syndrome at presentation and active hematologic treatment were independently associated with a worse prognosis. Neither diagnosis nor disease status affected the prognosis. The worst prognosis was demonstrated among patients on active hematologic treatment and those with more severe respiratory syndrome at COVID-19 presentation. Conclusions During the COVID-19 pandemic, patients should be advised to seek medical attention at the earliest signs of dyspnea and/or respiratory infection. Physicians should perform a risk-benefit analysis to determine the impact of temporarily deferring nonlifesaving treatments versus the risk of adverse outcomes associated with COVID-19. Lay SummaryCoronavirus disease 2019 (COVID-19) infection occurs across all different types of hematologic disease; however, the risk of acquiring it is lower for patients with chronic myeloproliferative neoplasms, including chronic myeloid leukemia, and higher for patients with immune-mediated anemia on immunosuppressive treatment. The 30-day mortality rate is 39.2%, which is far higher than the rates for both uninfected hematologic controls (3%;P < .001) and nonhematologic patients with COVID-19 (23.5%;P = .02) despite matching for age, sex, comorbidities, and severity of disease. Variables independently associated with a worse prognosis are the severity of the respiratory syndrome at presentation and any type of active hematologic treatment. Neither diagnosis nor disease status influence the prognosis.