Background: In this international multicenter study we aimed to determine the independent risk factors associated with increased 30-day mortality and the impact of cancer and novel treatment modalities in a large group of patients with and without cancer with COVID-19 from multiple countries.
Methods: We retrospectively collected de-identified data on a cohort of patients with and without cancer diagnosed with COVID-19 between January and November 2020, from 16 international centers.
Results: We analyzed 3966 COVID-19 confirmed patients, 1115 with cancer and 2851 nwithout cancer patients. Patients with cancer were more likely to be pancytopenic, and have a smoking history, pulmonary disorders, hypertension, diabetes mellitus, and corticosteroid use in the preceding two weeks (p≤0.01). In addition, they were more likely to present with higher inflammatory biomarkers (D-dimer, ferritin and procalcitonin), but were less likely to present with clinical symptoms (p≤0.01). By country-adjusted multivariable logistic regression analyses, cancer was not found to be an independent risk factor for 30-day mortality (p=0.18) whereas lymphopenia was independently associated with increased mortality in all patients, and in patients with cancer. Older age (≥65 years) was the strongest predictor of 30-day mortality in all patients(OR=4.47, p<0.0001). Remdesivir was the only therapeutic agent independently associated with decreased 30-day mortality ()(OR=0.64, p=0.036). Among patients on low-flow oxygen at admission, patients who received remdesivir had a lower 30-day mortality rate than those who did not (5.9% vs 17.6%; p=0.03).
Conclusions: Increased 30-day all-cause mortality from COVID-19 was not independently associated with cancer but was independently associated with lymphopenia often observed in hematolgic malignancy. Remdesivir, particularly in patients with cancer receiving low-flow oxygen, can reduce 30-day all-cause mortality.
Funding: National Cancer Institute, National Institutes of Health.
We are unable to share the data given our restriction policy and the fact that this study includes data from 16 centers from the five continents and we have no agreement in place to share data.*Thank you for indicating that you are unable to make this data publicly available and providing some further information regarding this. Exceptions to our usual data sharing policy are subject to editorial approval, as per our data availability policy [https://submit.elifesciences.org/html/elife_author_instructions.html#policies]. To enable the editors to make an informed decision, please can you provide further information on the data sharing plan for your manuscript. This information should be added to your data availability statement (found in the Submission Information section of the submission form). Some of these points may already be covered, however please ensure that the statement covers the following:- Please provide an explanation of why the data cannot be shared.We are unable to share our data given the restrictive policy of our institution. We also do not have the permission to share data from the other institutions that participated in this study- Please describe how an interested researcher would be able to access the original data e.g. Who would they need to contact? Do they need to apply or submit a project proposal? If so, who would assess this proposal (e.g. a data access committee or IRB)? Are there any restrictions on who can access the data e.g. could commercial research be performed on the data?Given that this study involves data from 16 centers from the five continents, we have no agreement to share data.- Please provide any code or software that you have used to analyse the data.The analyses were performed using SAS version 9.3 (SAS Institute Inc., Cary, NC).- Please provide access to all materials and data for which the restrictions do not apply. For instance, would it be possible to share a deidentified version of the dataset? If not, would you be able to share processed version of the dataset e.g. an Excel sheet with numbers used to plot the graphs and charts in your manuscript?We are unable to share the data.
- Issam I Raad
- Issam I Raad
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Human subjects: This study (Protocol # 2020-0437) was approved by the institutional review board at MD Anderson Cancer Center and the institutional review boards of the collaborating centers. A patient waiver of informed consent was obtained.
- Samra Turajlic, The Francis Crick Institute, United Kingdom
© 2023, Raad et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
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