Systemic pro-inflammatory response identifies patients with cancer with adverse outcomes from SARS-CoV-2 infection: the OnCovid Inflammatory Score.
Systemic pro-inflammatory response identifies patients with cancer with adverse outcomes from SARS-CoV-2 infection: the OnCovid Inflammatory Score.
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DOI：
10.1136/jitc-2020-002277
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发表时间：
2021-03
影响因子：
10.9
通讯作者：
OnCovid study group
中科院分区：
文献类型：
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作者：
Dettorre GM;Dolly S;Loizidou A;Chester J;Jackson A;Mukherjee U;Zambelli A;Aguilar-Company J;Bower M;Sng CCT;Salazar R;Bertuzzi A;Brunet J;Mesia R;Sita-Lumsden A;Seguí E;Biello F;Generali D;Grisanti S;Seeva P;Rizzo G;Libertini M;Maconi A;Moss C;Russell B;Harbeck N;Vincenzi B;Bertulli R;Ottaviani D;Liñan R;Marrari A;Carmona-García MC;Chopra N;Tondini CA;Mirallas O;Tovazzi V;Fotia V;Cruz CA;Saoudi-Gonzalez N;Felip E;Roqué A;Lee AJX;Newsom-Davis T;García-Illescas D;Reyes R;Wong YNS;Ferrante D;Scotti L;Marco-Hernández J;Ruiz-Camps I;Patriarca A;Rimassa L;Chiudinelli L;Franchi M;Santoro A;Prat A;Gennari A;Van Hemelrijck M;Tabernero J;Diamantis N;Pinato DJ;OnCovid study group
癌症患者特别容易感染SARS-CoV-2。全身炎症反应是癌症进展和COVID-19共有的致病机制。我们研究了全身炎症作为COVID-19严重程度和死亡率的驱动因素，评估了OnCovid研究中SARS-CoV-2感染癌症患者常用炎症指标的预后作用。在欧洲SARS-CoV-2感染的癌症患者的多中心队列中，我们评估了中性粒细胞：淋巴细胞比率（NLR）、血小板：淋巴细胞比率（PLR）、预后营养指数（PNI）（更名为OnCovid炎症评分（OIS））、改良格拉斯哥预后评分（mGPS）、以及与肿瘤学和COVID-19感染特征相关的预后指数（PI），在独立训练（n=529）和验证（n=542）集中测试其预后潜力。我们评估了1071例符合条件的患者，其中625例（58.3%）为男性，420例为晚期恶性肿瘤患者（39.2%），最常见的是泌尿生殖系统（n=216，20.2%）。844例（78.8%）有≥1种合并症，754例（70.4%）有≥1种COVID-19并发症。与COVID-19前的测量值相比，COVID-19诊断时的NLR、OIS和mGPS恶化（p<0.01），幸存者恢复到COVID-19前的水平。除PLR外，在训练集和验证集中，每个指标的风险类别较差的患者显示出较高的死亡率（p<0.001）和较短的中位总生存期（p<0.01）。多变量分析显示，OIS是生存率的最独立预测因素（验证集HR 2.48，95% CI 1.47 - 4.20，p=0.001;校正一致性指数评分0.611）。全身炎症是SARS-CoV-2感染的癌症患者的一个有效的预后领域，可用作不良结局的床边预测因子。OIS计算的淋巴细胞减少症和低白蛋白血症是严重COVID-19的独立预测指标，支持将其用于风险分层。抑制COVID-19诱导的促炎状态是癌症患者的一种公认治疗策略。
Patients with cancer are particularly susceptible to SARS-CoV-2 infection. The systemic inflammatory response is a pathogenic mechanism shared by cancer progression and COVID-19. We investigated systemic inflammation as a driver of severity and mortality from COVID-19, evaluating the prognostic role of commonly used inflammatory indices in SARS-CoV-2-infected patients with cancer accrued to the OnCovid study. In a multicenter cohort of SARS-CoV-2-infected patients with cancer in Europe, we evaluated dynamic changes in neutrophil:lymphocyte ratio (NLR); platelet:lymphocyte ratio (PLR); Prognostic Nutritional Index (PNI), renamed the OnCovid Inflammatory Score (OIS); modified Glasgow Prognostic Score (mGPS); and Prognostic Index (PI) in relation to oncological and COVID-19 infection features, testing their prognostic potential in independent training (n=529) and validation (n=542) sets. We evaluated 1071 eligible patients, of which 625 (58.3%) were men, and 420 were patients with malignancy in advanced stage (39.2%), most commonly genitourinary (n=216, 20.2%). 844 (78.8%) had ≥1 comorbidity and 754 (70.4%) had ≥1 COVID-19 complication. NLR, OIS, and mGPS worsened at COVID-19 diagnosis compared with pre-COVID-19 measurement (p<0.01), recovering in survivors to pre-COVID-19 levels. Patients in poorer risk categories for each index except the PLR exhibited higher mortality rates (p<0.001) and shorter median overall survival in the training and validation sets (p<0.01). Multivariable analyses revealed the OIS to be most independently predictive of survival (validation set HR 2.48, 95% CI 1.47 to 4.20, p=0.001; adjusted concordance index score 0.611). Systemic inflammation is a validated prognostic domain in SARS-CoV-2-infected patients with cancer and can be used as a bedside predictor of adverse outcome. Lymphocytopenia and hypoalbuminemia as computed by the OIS are independently predictive of severe COVID-19, supporting their use for risk stratification. Reversal of the COVID-19-induced proinflammatory state is a putative therapeutic strategy in patients with cancer.
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