Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome

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Lee, RJ, Wysocki, O, Bhogal, T ORCID: 0000-0003-3297-9957, Shotton, R, Tivey, A, Angelakas, A, Aung, T, Banfill, K, Baxter, M, Boyce, H et al (show 30 more authors) , Brearton, G, Copson, E, Dickens, E, Eastlake, L, Gomes, F, Hague, C, Harrison, M, Horsley, L, Huddar, P, Hudson, Z, Khan, S, Khan, UT ORCID: 0000-0002-9470-3481, Maynard, A, McKenzie, H, Palmer, D ORCID: 0000-0002-7147-5703, Robinson, T, Rowe, M, Thomas, A, Tweedy, J, Sheehan, R, Stockdale, A ORCID: 0000-0002-5828-3328, Weaver, J, Williams, S, Wilson, C, Zhou, C, Dive, C, Cooksley, T, Palmieri, C ORCID: 0000-0001-9496-2718, Freitas, A and Armstrong, AC (2021) Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome. ESMO OPEN, 6 (1). 100005-.

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Abstract

<h4>Background</h4>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.<h4>Patients and methods</h4>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.<h4>Results</h4>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 < 0.001), platelet count (P = 0.03), LDH (P < 0.0001) and albumin (P < 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.<h4>Conclusion</h4>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.

Item Type:	Article
Uncontrolled Keywords:	COVID-19, cancer, SARS-CoV-2
Depositing User:	Symplectic Admin
Date Deposited:	15 Feb 2021 08:37
Last Modified:	18 Jan 2023 23:00
DOI:	10.1016/j.esmoop.2020.100005
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3115609