Abstract
BackgroundSeveral studies report an increased susceptibility to SARS-CoV-2 infection in cancer patients. However, data in the intensive care unit (ICU) are scarce.Research QuestionWe aimed to investigate the association between active cancer and mortality among patients requiring organ support in the ICU.Study Design and MethodsIn this ambispective study encompassing 17 hospitals in France, we included all adult active cancer patients with SARS-CoV-2 infection requiring organ support and admitted in ICU. For each cancer patient, we included 3 non cancer patients as controls. Patients were matched at the same ratio using the inverse probability weighting approach based on a propensity score assessing the probability of cancer at admission. Mortality at day 60 after ICU admission was compared between cancer patients and non-cancer patients using primary logistic regression analysis and secondary multivariable analyses.ResultsBetween March 12, 2020 and March 8, 2021, 2608 patients were admitted with SARS-CoV-2 infection in our study, accounting for 2.8% of the total population of patients with SARS-CoV-2 admitted in all French ICUs within the same period. Among them, 105 (n=4%) presented with cancer (51 patients had hematological malignancy and 54 patients had solid tumors). 409 of 420 patients were included in the propensity score matching process, of whom 307 patients in the non-cancer group and 102 patients in the cancer group. 145 patients (35%) died in the ICU at day 60, 59 (56%) with cancer and 86 (27%) without cancer. In the primary logistic regression analysis, the odds ratio for death associated to cancer was 2.3 (95%CI 1.24 – 4.28, p=0.0082) higher for cancer patients than for a non-cancer patient at ICU admission. Exploratory multivariable analyses showed that solid tumor (OR: 2.344 (0.87-6.31), p=0.062) and hematological malignancies (OR: 4.144 (1.24-13.83), p=0.062) were independently associated with mortality.InterpretationPatients with cancer and requiring ICU admission for SARS-CoV-2 infection had an increased mortality, hematological malignancy harboring the higher risk in comparison to solid tumors.
Highlights
Several studies report an increased susceptibility to SARS-CoV-2 infection in cancer patients
Between March 12, 2020 and March 8, 2021, 2608 patients were admitted with SARS-CoV-2 infection in our study, accounting for 2.8% of the total population of patients with SARS-CoV-2 admitted in all French intensive care unit (ICU) within the same period
In the primary logistic regression analysis, the odds ratio for death associated to cancer was 2.3 (95%confidence intervals (CIs) 1.24 – 4.28, p=0.0082) higher for cancer patients than for a non-cancer patient at ICU admission
Summary
Several studies report an increased susceptibility to SARS-CoV-2 infection in cancer patients. Research Question: We aimed to investigate the association between active cancer and mortality among patients requiring organ support in the ICU. Ever since it was first reported in China in late 2019, coronavirus disease 2019 (COVID-19) has impacted millions of patients worldwide. It is well documented that this disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, preferentially affects the elderly and those with comorbidities [1, 2] Among frail patients, those with cancer are reported to harbor an increased susceptibility to SARS-COV-2 infection [3]. Data in the ICU setting are scarce, most studies have identified a higher risk of mortality in cancer patients [6] Several confounding factors, such as specific patient case-mix, cancer treatment, or progression status, may explain this discrepancy. Considering cancer-related immunosuppression, data regarding ICU-acquired infections that could prolong ICU morbidity and mortality are scarce
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