Clinical characteristics and outcomes among critically ill patients with cancer and COVID-19-related acute respiratory failure
Ying-Ting Liao, Hsiao-Chin Shen, Jhong-Ru Huang, Chuan-Yen Sun, Hung-Jui Ko, Chih-Jung Chang, Yuh-Min Chen, Jia-Yih Feng, Wei-Chih Chen, Kuang-Yao Yang
BMC Pulmonary Medicine, doi:10.1186/s12890-024-02850-z
Background Coronavirus disease 2019 (COVID-19) has affected individuals worldwide, and patients with cancer are particularly vulnerable to COVID-19-related severe illness, respiratory failure, and mortality. The relationship between COVID-19 and cancer remains a critical concern, and a comprehensive investigation of the factors affecting survival among patients with cancer who develop COVID-19-related respiratory failure is warranted. We aim to compare the characteristics and outcomes of COVID-19-related acute respiratory failure in patients with and without underlying cancer, while analyzing factors affecting in-hospital survival among cancer patients.
Methods We conducted a retrospective observational study at Taipei Veterans General Hospital in Taiwan from May to September 2022, a period during which the omicron variant of the severe acute respiratory syndrome coronavirus 2 was circulating. Eligible patients had COVID-19 and acute respiratory failure. Clinical data, demographic information, disease severity markers, treatment details, and outcomes were collected and analyzed.
Results Of the 215 enrolled critically ill patients with COVID-19, 65 had cancer. The patients with cancer were younger and had lower absolute lymphocyte counts, higher ferritin and lactate dehydrogenase (LDH) concentrations, and increased vasopressor use compared with those without cancer. The patients with cancer also received more COVID-19 specific treatments but had higher in-hospital mortality rate (61.5% vs 36%, P = 0.002) and longer viral shedding (13 vs 10 days, P = 0.007) than those without cancer did. Smoking [odds ratio (OR): 5.804, 95% confidence interval (CI): 1.847-39.746], elevated LDH (OR: 1.004, 95% CI: 1.001-1.012), vasopressor use (OR: 5.437, 95% CI: 1.202-24.593), and new renal replacement therapy (OR: 3.523, 95% CI: 1.203-61.108) were independent predictors of in-hospital mortality among patients with cancer and respiratory failure.
Conclusion Critically ill patients with cancer experiencing COVID-19-related acute respiratory failure present unique clinical features and worse clinical outcomes compared with those without cancer. Smoking, elevated LDH, vasopressor use, and new renal replacement therapy were risk factors for in-hospital mortality in these patients.
Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1186/ s12890-024-02850-z. Additional file 1.
Authors' contributions Conceptualization: Ying-Ting Liao, Hsiao-Chin Shen, Jhong-Ru Huang, Chuan-Yen Sun, Hung-Jui Ko, Chih-Jung Chang, Jia-Yih Feng, Wei-Chih Chen, Kuang-Yao Yang. Supervision: Wei-Chih Chen, Jia-Yih Feng, Kuang-Yao Yang, Yuh-Min Chen. Data Collection and/or Processing: Hsiao-Chin Shen, Chuan-Yen Sun, Jhong-Ru Huang, Ying-Ting Liao, Hung-Jui Ko, Chih-Jung Chang. Analysis and/ or Interpretation: Ying-Ting Liao, Wei-Chih Chen, Kuang-Yao Yang. Writingoriginal draft: Ying-Ting Liao, Wei-Chih Chen, Kuang-Yao Yang. Writing -review and editing: Ying-Ting Liao, Wei-Chih Chen, Kuang-Yao Yang. All authors read and approved the final manuscript.
Declarations Ethics approval and consent to participate This retrospective study was performed in accordance with the Declaration of Helsinki and approved by the Institutional Ethical Review Board of Taipei Veterans General Hospital (Approval No. 2022-11-002 AC). Written informed consent was waived by Institutional Ethical Review Board of Taipei Veterans General Hospital due to retrospective design of the study.
Consent for publication Not applicable.
Competing interests The authors declare no competing interests.
Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
Alhazzani, Møller, Arabi, Surviving Sepsis campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19), Intensive Care Med,
doi:10.1007/s00134-020-06022-5Aziz, Haghbin, Sitta, Efficacy of tocilizumab in COVID-19: a systematic review and meta-analysis, J Med Virol,
doi:10.1002/jmv.26509Coomes, Haghbayan, Interleukin-6 in Covid-19: a systematic review and meta-analysis, Rev Med Virol,
doi:10.1002/rmv.2141Elhadad, Bronstein, Yana, Characteristics and outcomes of patients infected with SARS-CoV-2 in Israel: correlation between laboratory findings on admission to emergency department and subsequent respiratory failure, Isr Med Assoc J
Espejo-Paeres, Núñez-Gil, Estrada, Impact of smoking on COVID-19 outcomes: a HOPE registry subanalysis, BMJ Nutr Prev Health,
doi:10.1136/bmjnph-2021-000269Feld, Tremblay, Thibaud, Kessler, Naymagon, Ferritin levels in patients with COVID-19: a poor predictor of mortality and hemophagocytic lymphohistiocytosis, Int J Lab Hematol,
doi:10.1111/ijlh.13309Garassino, Whisenant, Huang, COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study, The Lancet Oncol,
doi:10.1016/S1470-2045(20)30314-4Goubet, Dubuisson, Geraud, Prolonged SARS-CoV-2 RNA virus shedding and lymphopenia are hallmarks of COVID-19 in cancer patients with poor prognosis, Cell Death Different,
doi:10.1038/s41418-021-00817-9Grivas, Khaki, Wise-Draper, Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer consortium, Ann Oncol,
doi:10.1016/j.annonc.2021.02.024Gómez-Pastora, Weigand, Kim, Hyperferritinemia in critically ill COVID-19 patients -is ferritin the product of inflammation or a pathogenic mediator?, Clin Chim Acta,
doi:10.1016/j.cca.2020.06.033Illg, Muller, Mueller, Nippert, Allen, Analysis of absolute lymphocyte count in patients with COVID-19, Am J Emerg Med,
doi:10.1016/j.ajem.2021.02.054Kao, Lai, Hung, Sequential oxygenation index and organ dysfunction assessment within the first 3 days of mechanical ventilation predict the outcome of adult patients with severe acute respiratory failure, Sci World J,
doi:10.1155/2013/413216Kaushal, Kaur, Sarma, Serum ferritin as a predictive biomarker in COVID-19. A systematic review, meta-analysis and meta-regression analysis, J Crit Care,
doi:10.1016/j.jcrc.2021.09.023Knaus, Draper, Wagner, Zimmerman, APACHE II: a severity of disease classification system, Crit Care Med
Kumari, Dwarakanath, Das, Bhatt, Role of interleukin-6 in cancer progression and therapeutic resistance, Tumour Biol,
doi:10.1007/s13277-016-5098-7Lecuyer, Chevret, Thiery, Darmon, Schlemmer et al., The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation, Crit Care Med,
doi:10.1097/01.Ccm.0000256846.27192.7aLee, Cazier, Angelis, COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study, Lancet,
doi:10.1016/s0140-6736(20)31173-9Li, Ye, Chen, Elevated Lactate Dehydrogenase (LDH) level as an independent risk factor for the severity and mortality of COVID-19, Aging,
doi:10.18632/aging.103770Malik, Patel, Mehta, Biomarkers and outcomes of COVID-19 hospitalisations: systematic review and meta-analysis, BMJ Evid Based Med,
doi:10.1136/bmjebm-2020-111536Mesa, César, Martín-Montañez, Acute lung injury biomarkers in the prediction of COVID-19 severity: Total thiol, ferritin and lactate dehydrogenase, Antioxidants,
doi:10.3390/antiox10081221Michard, Malbrain, Martin, Haemodynamic monitoring and management in COVID-19 intensive care patients: an international survey, Anaesth Crit Care Pain Med,
doi:10.1016/j.accpm.2020.08.001Patanavanich, Glantz, Smoking Is Associated With COVID-19 Progression: A Meta-analysis, Nicotine Tob Res,
doi:10.1093/ntr/ntaa082Smith, Sausville, Girish, Cigarette Smoke Exposure and Inflammatory Signaling Increase the Expression of the SARS-CoV-2 Receptor ACE2 in the Respiratory Tract, Dev Cell,
doi:10.1016/j.devcel.2020.05.012Topp, Bouyea, Cochran-Caggiano, Biomarkers predictive of Extubation and survival of COVID-19 patients, Cureus,
doi:10.7759/cureus.15462Van Paassen, Vos, Hoekstra, Neumann, Boot et al., Corticosteroid use in COVID-19 patients: a systematic review and metaanalysis on clinical outcomes, Crit Care,
doi:10.1186/s13054-020-03400-9Vincent, Moreno, Takala, The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the working group on Sepsis-related problems of the European Society of Intensive Care Medicine, Intensive Care Med,
doi:10.1007/bf01709751Yekedüz, Utkan, Ürün, A systematic review and meta-analysis: the effect of active cancer treatment on severity of COVID-19, Eur J Cancer,
doi:10.1016/j.ejca.2020.09.028Young, Ong, Ng, Viral Dynamics and Immune Correlates of Coronavirus Disease 2019 (COVID-19) Severity, Clin Infect Dis,
doi:10.1093/cid/ciaa1280Zhao, Meng, Kumar, The impact of COPD and smoking history on the severity of COVID-19: a systemic review and meta-analysis, J Med Virol,
doi:10.1002/jmv.25889Zong, Wei, Ren, Zhang, Zhou, The intersection of COVID-19 and cancer: signaling pathways and treatment implications, Mol Cancer,
doi:10.1186/s12943-021-01363-1
