tetano
Editor, Senior Moderator
Clin Infect Pract
. 2022 Jan;13:100137.
doi: 10.1016/j.clinpr.2022.100137. Epub 2022 Feb 15.
Higher mortality of hospitalized haematologic patients with COVID-19 compared to non-haematologic is driven by thrombotic complications and development of ARDS: An age-matched cohorts study
Ana Fernández-Cruz[SUP] 1 2 [/SUP], Alba Puyuelo[SUP] 3 [/SUP], Lucía Núñez Martín-Buitrago[SUP] 3 [/SUP], Enrique Sánchez-Chica[SUP] 4 [/SUP], Carmen Díaz-Pedroche[SUP] 5 6 7 [/SUP], Rosa Ayala[SUP] 8 6 [/SUP], Manuel Lizasoain[SUP] 9 6 [/SUP], Rafael Duarte[SUP] 3 2 10 [/SUP], Carlos Lumbreras[SUP] 9 6 7 [/SUP], Juan Antonio Vargas[SUP] 4 2 10 [/SUP]
Affiliations
Abstract
Background and objectives: The characteristics of COVID-19 in haematologic patients compared to non-haematologic patients have seldom been analyzed. Our aim was to analyze whether there are differences in clinical characteristics and outcome of haematologic patients with COVID-19 as compared to non-haematologic.
Patients and methods: Retrospective cohort study in 2 University hospitals of patients admitted with laboratory-confirmed COVID-19 included in the SEMICOVID19 database. The cohort with underlying haematologic disease was compared to a cohort of age and date-of-COVID-19-matched controls without haematologic disease (1:2).
Results: 71 cases and 142 controls were included from March-May 2020.Twenty (28.1%) had received recent chemotherapy. Twelve (16.9%) were stem cell transplant recipients (SCT). Eleven (15.5%) were neutropenic concurrently with COVID-19 diagnosis.Haematologic patients presented ARDS (58.5 vs 20.7%, p = 0.0001), thrombotic complications (15.7 vs 2.1%, p = 0.002), DIC (5.7 vs 0.0%, p = 0.011), heart failure (14.3 vs 4.9%, p = 0.029) and required ICU admission (15.5 vs 2.8%, p = 0.001), MV (14.1% vs 2.1%, p 0.001), steroid (64.8 vs 33.1%, p = 0.0001), tocilizumab (33.8 vs 8.5%, p = 0.0001) or anakinra treatment (9.9% vs 0%, p = 0.0001) more often. In-hospital mortality was significantly higher (38.0% vs 18.3%, p = 0.002).
Conclusions: Our results suggest COVID-19 has worse outcomes in haematologic patients than in non-haematologic, independently of age, and that the development of ARDS and thrombotic complications drive the higher in-hospital mortality.
Keywords: ARDS, acute respiratory distress syndrome; C-RP, C-reactive protein; CI, confidence interval; CLL, chronic lymphocytic leukemia; COVID-19; COVID-19, Coronavirus disease 2019; DIC, disseminated intravascular coagulation; ECOG scale, Eastern Cooperative Oncology Group scale; G-CSF, granulocyte stimulating factor; HFNC, high flow nasal cannula; Haematologic; ICU, Intensive Care Unit; IL6, Interleukin 6; IQR, interquartile range; LDH, Lactate dehydrogenase; MDS, myelodysplastic syndrome; MM, multiple myeloma; MV, mechanical ventilation; Mortality; NHL, non-Hodgkin lymphoma; NIMV, non-invasive mechanical ventilation; OR, Odds ratio; Outcome; PEEP, positive end expiratory pressure; PaO2/FiO2, arterial oxygen tension/inspiratory oxygen fraction; SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2; SCT, stem cell transplantation; SD, standard deviation.
. 2022 Jan;13:100137.
doi: 10.1016/j.clinpr.2022.100137. Epub 2022 Feb 15.
Higher mortality of hospitalized haematologic patients with COVID-19 compared to non-haematologic is driven by thrombotic complications and development of ARDS: An age-matched cohorts study
Ana Fernández-Cruz[SUP] 1 2 [/SUP], Alba Puyuelo[SUP] 3 [/SUP], Lucía Núñez Martín-Buitrago[SUP] 3 [/SUP], Enrique Sánchez-Chica[SUP] 4 [/SUP], Carmen Díaz-Pedroche[SUP] 5 6 7 [/SUP], Rosa Ayala[SUP] 8 6 [/SUP], Manuel Lizasoain[SUP] 9 6 [/SUP], Rafael Duarte[SUP] 3 2 10 [/SUP], Carlos Lumbreras[SUP] 9 6 7 [/SUP], Juan Antonio Vargas[SUP] 4 2 10 [/SUP]
Affiliations
- PMID: 35187467
- PMCID: PMC8843327
- DOI: 10.1016/j.clinpr.2022.100137
Abstract
Background and objectives: The characteristics of COVID-19 in haematologic patients compared to non-haematologic patients have seldom been analyzed. Our aim was to analyze whether there are differences in clinical characteristics and outcome of haematologic patients with COVID-19 as compared to non-haematologic.
Patients and methods: Retrospective cohort study in 2 University hospitals of patients admitted with laboratory-confirmed COVID-19 included in the SEMICOVID19 database. The cohort with underlying haematologic disease was compared to a cohort of age and date-of-COVID-19-matched controls without haematologic disease (1:2).
Results: 71 cases and 142 controls were included from March-May 2020.Twenty (28.1%) had received recent chemotherapy. Twelve (16.9%) were stem cell transplant recipients (SCT). Eleven (15.5%) were neutropenic concurrently with COVID-19 diagnosis.Haematologic patients presented ARDS (58.5 vs 20.7%, p = 0.0001), thrombotic complications (15.7 vs 2.1%, p = 0.002), DIC (5.7 vs 0.0%, p = 0.011), heart failure (14.3 vs 4.9%, p = 0.029) and required ICU admission (15.5 vs 2.8%, p = 0.001), MV (14.1% vs 2.1%, p 0.001), steroid (64.8 vs 33.1%, p = 0.0001), tocilizumab (33.8 vs 8.5%, p = 0.0001) or anakinra treatment (9.9% vs 0%, p = 0.0001) more often. In-hospital mortality was significantly higher (38.0% vs 18.3%, p = 0.002).
Conclusions: Our results suggest COVID-19 has worse outcomes in haematologic patients than in non-haematologic, independently of age, and that the development of ARDS and thrombotic complications drive the higher in-hospital mortality.
Keywords: ARDS, acute respiratory distress syndrome; C-RP, C-reactive protein; CI, confidence interval; CLL, chronic lymphocytic leukemia; COVID-19; COVID-19, Coronavirus disease 2019; DIC, disseminated intravascular coagulation; ECOG scale, Eastern Cooperative Oncology Group scale; G-CSF, granulocyte stimulating factor; HFNC, high flow nasal cannula; Haematologic; ICU, Intensive Care Unit; IL6, Interleukin 6; IQR, interquartile range; LDH, Lactate dehydrogenase; MDS, myelodysplastic syndrome; MM, multiple myeloma; MV, mechanical ventilation; Mortality; NHL, non-Hodgkin lymphoma; NIMV, non-invasive mechanical ventilation; OR, Odds ratio; Outcome; PEEP, positive end expiratory pressure; PaO2/FiO2, arterial oxygen tension/inspiratory oxygen fraction; SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2; SCT, stem cell transplantation; SD, standard deviation.