• Brearton, G.
• Maynard, A.
• Stockdale, A.
• Freitas, Andre
• Zhou, C.
• Huddar, P.
• Williams, S.
• Angelakas, A.
• Tweedy, J.
• Cooksley, T.
• Gomes, F.
• Shotton, R.
• Dickens, E.
• Rowe, M.
• Wysocki, O.
• Palmer, D.
• Khan, U. T.
• Copson, E.
• Weaver, J.
• Harrison, M.
• Sheehan, R.
• Baxter, M.
• Wilson, C.
• Hudson, Z.
• Aung, T.
• Armstrong, C. A.
• Horsley, L.
• Robinson, T.
• Tivey, A.
• Lee, Rebecca
• Palmieri, C.
• Hague, C.
• Mckenzie, H.
• Bhogal, T.
• Eastlake, L.
• Thomas, A.
• Dive, C.
• Banfill, Kathryn
• Boyce, H.
• Khan, S.

Abstract

<p>Background: Cancer patients are at increased risk of death from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer and its treatment affect many haematological and biochemical parameters, therefore we analysed these prior to and during coronavirus disease 2019 (COVID-19) and correlated them with outcome. </p><p>Patients and methods: Consecutive patients with cancer testing positive for SARS-CoV-2 in centres throughout the United Kingdom were identified and entered into a database following local governance approval. Clinical and longitudinal laboratory data were extracted from patient records. Data were analysed using Mann–Whitney U test, Fisher's exact test, Wilcoxon signed rank test, logistic regression, or linear regression for outcomes. Hierarchical clustering of heatmaps was performed using Ward's method. </p><p>Results: In total, 302 patients were included in three cohorts: Manchester (n = 67), Liverpool (n = 62), and UK (n = 173). In the entire cohort (N = 302), median age was 69 (range 19-93 years), including 163 males and 139 females; of these, 216 were diagnosed with a solid tumour and 86 with a haematological cancer. Preinfection lymphopaenia, neutropaenia and lactate dehydrogenase (LDH) were not associated with oxygen requirement (O₂) or death. Lymphocyte count (P &lt; 0.001), platelet count (P = 0.03), LDH (P &lt; 0.0001) and albumin (P &lt; 0.0001) significantly changed from preinfection to during infection. High rather than low neutrophils at day 0 (P = 0.007), higher maximal neutrophils during COVID-19 (P = 0.026) and higher neutrophil-to-lymphocyte ratio (NLR; P = 0.01) were associated with death. In multivariable analysis, age (P = 0.002), haematological cancer (P = 0.034), C-reactive protein (P = 0.004), NLR (P = 0.036) and albumin (P = 0.02) at day 0 were significant predictors of death. In the Manchester/Liverpool cohort 30 patients have restarted therapy following COVID-19, with no additional complications requiring readmission. </p><p>Conclusion: Preinfection biochemical/haematological parameters were not associated with worse outcome in cancer patients. Restarting treatment following COVID-19 was not associated with additional complications. Neutropaenia due to cancer/treatment is not associated with COVID-19 mortality. Cancer therapy, particularly in patients with solid tumours, need not be delayed or omitted due to concerns that treatment itself increases COVID-19 severity.</p>

Topics

• impedance spectroscopy
• Oxygen
• reactive
• clustering