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Systemic pro-inflammatory response identifies cancer patients with adverse outcomes from SARS-CoV-2 infection: the OnCovid inflammatory score

Detttorre, Gino M., Dolly, Saoirse, Loizidou, Angela, Chester, John ORCID:, Jackson, Amanda, Mukherjee, Uma, Zambelli, Alberto, Aguilar-Company, Juan, Bower, Mark, Sng, Christopher C. T., Salazar, Ramon, Bertuzzi, Alexia, Brunet, Joan, Mesia, Ricard, Sita-Lumsden, Alisa, Segui, Elia, Biello, Federica, Gnerali, Daniele, Grisanti, Salbatore, Seeva, Pavetha, Rizzo, Gianpiero, Libertini, Michela, Maconi, Antonio, Moss, Charlotte, Russell, Beth, Harbeck, Nadia, Vincenzi, Bruno, Bertulli, Rossella, Ottaviani, Diego, Linan, Raquel, Marrari, Andrea, Carmona-Garcia, M. Carmen, Chopra, Neha, Tondini, Carlo, Mirallas, Oriol, Tobazzi, Valeria, Fotia, Raquel, Cruz, Claudia Andrea, Saoudi-Gonzalez, Nadia, Felip, Eudald, Roque, Ariadna, Lee, Alvin J. X., Newsom-Davis, Thomas, Garcia-Illescas, David, Reyes, Roxana, Wong, Yien Ning Sophia, Ferrante, Daniela, Scott, Lorenza, Marco-Hernandez, Javier, Ruiz-Camps, Isabel, Patiarca, Andrea, Rimassa, Lorenza, Chiudinelli, Lorenzo, Franchi, Michela, Santoro, Armando, Prat, Aleix, Tabernero, Josep, Gennari, Alessandra, Van Hemelrijck, Mieke, Diamantis, Nikolaos, Pinato, David J. and OnCovid, study group 2021. Systemic pro-inflammatory response identifies cancer patients with adverse outcomes from SARS-CoV-2 infection: the OnCovid inflammatory score. Journal for ImmunoTherapy of Cancer 9 , e002277. 10.1136/jitc-2020-002277

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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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license
Publisher: BMJ
ISSN: 2051-1426
Date of First Compliant Deposit: 31 March 2021
Date of Acceptance: 5 February 2021
Last Modified: 06 May 2023 07:03

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