COVID-19 in patients with active - higher inflammatory activity predicts poor outcome.

Abstract

Abstract Introduction: Active malignancies have been identified as an independent risk-factor for severity and mortality in COVID-19. However, direct comparisons between SARS-CoV-2 infected patients with active (acP) and non-active cancers (n-acP) remain scarce. Patients and Methods: We retrospectively analyzed a cohort of cancer patients with PCR confirmed SARS-CoV-2 infection, enrolled from 03/16/2020 to 07/31/2021. Data on demographics, cancer, and laboratory findings were collected. Descriptive and subsequent regression analysis was performed. Endpoints were “deterioration to severe COVID-19” and “infection-associated mortality”. Results: In total, 987 cancer patients (510 acP vs 477 n-acP) were included in our analysis. The majority was >55 years, more men than women were included. At detection of SARS-CoV-2, 65.5% of patients had mild/moderate symptoms, while deterioration to severe COVID-19 was slightly more common in acP (19% vs 16%; p=0.284). COVID-19-associated mortality was significantly higher in acP (24% vs 17.5%, p<0.001). In terms of laboratory tests, severe cytopenia and elevated levels of inflammatory markers were common findings in acP at baseline, particularly in those, who developed a severe infection or died. Multivariate analysis revealed that ferritin (HR 14.24 [2.1–96], p=0.006) and CRP (HR 2.85 [1.02–8.02], p=0.046) were associated with severity and mortality. In n-acP, association was seen for ferritin only (HR 4.1 [1.51–11.17], p=0.006). Conclusion: Comparing patients with active and non-active cancer, the former showed higher mortality rates. Also, inflammatory markers were significantly increased assuming higher levels of inflammation may play a role in the adverse outcome of COVID-19 in aCP. This study is registered at the German Clinical Trials Register (registry name (DRSK), trial registration ID: S00021145). Date of registration: 08.04.2020.