Clinical characteristics and risk factors associated with COVID-19 severity in patients with haematological malignancies in Italy: a retrospective, multicentre, cohort study
Clinical characteristics and risk factors associated with COVID-19 severity in patients with haematological malignancies in Italy: a retrospective, multicentre, cohort study
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DOI：
10.1016/s2352-3026(20)30251-9
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发表时间：
2020-10-01
影响因子：
24.7
通讯作者：
Corradini, Paolo
中科院分区：
文献类型：
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作者：
Passamonti, Francesco;Cattaneo, Chiara;Corradini, Paolo
几项针对COVID-19和血液恶性肿瘤患者的小型研究显示，这一人群的死亡率很高。意大利COVID-19血液学联盟旨在收集因COVID-19需要住院治疗的成年血液恶性肿瘤患者的数据。方法这项多中心、回顾性、队列研究纳入了2020年2月25日至5月18日期间在意大利66家医院住院的诊断为世卫组织定义的血液系统恶性肿瘤的成年患者（年龄bb0 = 18岁），这些患者经实验室确诊并有症状的COVID-19。该分析的数据截止日期为2020年6月22日。主要结局是死亡率和死亡率潜在预测参数的评估。通过应用意大利COVID-19人群的分层特异性死亡率和31993例无COVID-19的血液恶性肿瘤患者的意大利队列（截至2019年3月1日的数据），我们计算了研究队列中观察到的死亡与预期死亡之间的标准化死亡率。采用多变量Cox比例风险模型确定与总生存率相关的因素。该研究已在ClinicalTrials.gov注册，编号NCT04352556，研究的前瞻性部分正在进行中。在数据截止时，我们纳入了536例患者，中位随访时间为20天（IQR 10-34），其中85例（16%）为门诊患者。451名住院患者中有440名（98%）完成了住院治疗（活着出院或死亡）。536例患者中198例（37%）死亡。与意大利普通COVID-19人群相比，标准化死亡率为2.04 （95% CI 1）。77-2-34), 3。72 （2 - 86）64)年龄小于70岁的人。与非covid -19血液系统恶性肿瘤队列相比，标准化死亡率为41.3（38.1-44.9）。高龄（风险比1.03,95%可信区间1）。01-1。05);疾病进展状态（2.10,1.41-3.12）；急性髓性白血病的诊断(3)。49,1.56 -7.81)，无痛非霍奇金淋巴瘤（2.19,1.07 -4）。48)，侵袭性非霍奇金淋巴瘤（2- 56,1 - 34-4）。89)或浆细胞肿瘤（2.48,1）。31-4.69)，重症或危重型（4.08,2.73-6.09）总生存率较差。本研究进一步证明，恶性血液病患者的预后比普通COVID-19患者和未患COVID-19的恶性血液病患者更差。因COVID-19住院的血液恶性肿瘤患者的高死亡率突出表明，至少在获得有效的疫苗接种或治疗策略之前，需要采取积极的感染预防策略。爱思唯尔版权所有版权所有。
Background Several small studies on patients with COVID-19 and haematological malignancies are available showing a high mortality in this population. The Italian Hematology Alliance on COVID-19 aimed to collect data from adult patients with haematological malignancies who required hospitalisation for COVID-19.Methods This multicentre, retrospective, cohort study included adult patients (aged >= 18 years) with diagnosis of a WHO-defined haematological malignancy admitted to 66 Italian hospitals between Feb 25 and May 18, 2020, with laboratory-confirmed and symptomatic COVID-19. Data cutoff for this analysis was June 22, 2020. The primary outcome was mortality and evaluation of potential predictive parameters of mortality. We calculated standardised mortality ratios between observed death in the study cohort and expected death by applying stratum-specific mortality rates of the Italian population with COVID-19 and an Italian cohort of 31993 patients with haematological malignancies without COVID-19 (data up to March 1, 2019). Multivariable Cox proportional hazards model was used to identify factors associated with overall survival. This study is registered with ClinicalTrials.gov , NCT04352556, and the prospective part of the study is ongoing.Findings We enrolled 536 patients with a median follow-up of 20 days (IQR 10-34) at data cutoff, 85 (16%) of whom were managed as outpatients. 440 (98%) of 451 hospitalised patients completed their hospital course (were either discharged alive or died). 198 (37%) of 536 patients died. When compared with the general Italian population with COVID-19, the standardised mortality ratio was 2.04 (95% CI 1. 77-2-34) in our whole study cohort and 3. 72 (2 - 86 4 . 64) in individuals younger than 70 years. When compared with the non-COVID-19 cohort with haematological malignancies, the standardised mortality ratio was 41.3 (38.1-44.9). Older age (hazard ratio 1.03, 95% CI 1 . 01-1. 05); progressive disease status (2.10, 1.41-3.12); diagnosis of acute myeloid leukaeinia (3 . 49, 1.56-7.81), indolent non-Hodgin lymphoma (2.19, 1.07-4. 48), aggressive non-Hodgkin lymphoma (2-56, 1- 34-4 . 89), or plasma cell neoplasms (2.48, 1. 31-4.69), and severe or critical COVID-19 (4.08, 2.73-6.09) were associated with worse overall survival.Interpretation This study adds to the evidence that patients with haematological malignancies have worse outcomes than both the general population with COVID-19 and patients with haematological malignancies without COVID-19. The high mortality among patients with haematological malignancies hospitalised with COVID-19 highlights the need for aggressive infection prevention strategies, at least until effective vaccination or treatment strategies are available. Copyright (C) 2020 Elsevier Ltd. All rights reserved.