Dettorre, GM; Dolly, S; Loizidou, A; Chester, J; Jackson, A; Mukherjee, U; Zambelli, A; ... OnCovid study group; + view all 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; - view fewer (2021) Systemic pro-inflammatory response identifies patients with cancer with adverse outcomes from SARS-CoV-2 infection: the OnCovid Inflammatory Score. Journal for ImmunoTherapy of Cancer , 9 (3) , Article e002277. 10.1136/jitc-2020-002277.

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Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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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