MA12.02 Factors Associated with Severe COVID-19 Infections in Lung Cancer Patients

Abstract

Lung cancer patients are at increased risk of developing complications from COVID-19 disease. Real-world data may better identify lung cancer patients who are at an increased risk of developing complications while maximizing the benefit of anti-cancer therapy. We conducted a retrospective cohort study using the VA COVID-19 Shared Data Resource (CSDR), VA Cancer Registry, and VA Corporate Data Warehouse (CDW), which centralizes electronic health data for patients seen at VA facilities nationwide. We included patients with a diagnosis of lung cancer between October 1, 2015 and December 1, 2020, and a diagnosis of COVID-19 between February 2, 2020 and December 1, 2020. Serious SARS-CoV-2 infection was defined as the occurrence of any of the following within 2 weeks after diagnosis: (a) hospitalization, (b) ICU admission, (c) utilization of respiratory support (mechanical ventilation or intubation). Data abstracted included: age at COVID-19 diagnosis, gender, race, ethnicity, urban status, date of diagnosis of lung cancer, histology, stage, cancer treatment, individual comorbidities and most recent laboratory results prior to COVID-19 diagnosis. Patients were stratified into 3 groups: mild/moderate COVID-19 infection, serious, but non-fatal infection, fatal infection. Differences in categorical variables, were assessed using χ2 test, while Kruskal-Wallis rank sum test was used for continuous variables. Multivariable logistic regression models were fit relative to the outcomes of interest, i.e., serious SARS-CoV-2 infection and death from SARS-CoV-2 infection. We identified 352 lung cancer patients with COVID-19. Of these, 54 (15.3%) had severe disease and 34 others (9.7%) died. Patients who had fatal or severe infection were older than those with mild/moderate infection (median age: 74.1 and 73.8 yrs vs. 72.1 yrs; p=0.01). Patients who suffered a fatal or severe infection were also more likely than patients with mild/moderate infection to exhibit elevated creatinine levels (50.0% and 31.5%, vs. 20.5%, p = 0.003) and low hemoglobin levels (67.6% and 51.9%, vs. 39.0%, p = 0.003). In addition, 70.6% of patients who died within two weeks of SARS-CoV-2 infection suffered from diabetes, compared to 40.2% of patients with mild/moderate infection.On multivariable logistic regression, variables associated with increased odds of severe infection or death were: age (OR: 1.07; 95% CI 1.03-1.12; p=0.002), stage IV (6.06; 1.19-30.84; 0.03), elevated creatinine (2.29; 1.2-4.39; 0.01), anemia (2.02, 1.07-3.83; 0.03). Type of cancer treatment, recent surgery or radiation, chronic obstructive pulmonary disease, hypertension, diabetes, acute myocardial infection were not associated with an increased risk of severe/fatal infection. Factors associated with fatal infection included checkpoint inhibitor therapy (OR: 7.06; 95% CI, 1.21-41.11; p=0.03), diabetes (3.53; 1.9-11.46; 0.04) and abnormal creatinine level (4.48; 1.52-13.15; 0.006). Almost 25% of lung cancer patients with COVID-19 infection developed complications or died. Increasing age, stage IV disease, abnormal kidney function and low hemoglobin level were associated with a severe/fatal SARS-CoV-2 infection, while checkpoint inhibitor therapy, diabetes and abnormal creatinine levels were associated with increased mortality from COVID-19 disease.