The effect of malignancy on prognosis in ICU patients with COVID-19

Abstract

Background: It is known that COVID-19 has a worse and poorer progression, which often might lead to death in those with comorbidities. Multiple studies have recently examined the clinical course of cancer patients with COVID-19 and new guidelines have been developed to manage this group of patients. This study aimed to evaluate the clinical course and mortality rate of cancer patients admitted to the intensive care unit (ICU) for COVID-19.
 Material and Method: The demographic characteristics, detailed medical history and laboratory findings of 140 patients with malignancy, who were treated in the COVID-19 Intensive Care Unit of Ankara City Hospital, were evaluated retrospectively. Gender, age, comorbidity, length of stay in the ICU, mortality rates, length of stay on a mechanical ventilator, cytokine storm scores, ferritin, interleukin 6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT), D-dimer, lactate dehydrogenase (LDH), lymphocyte count and treatment options were compared. The patients were divided into two groups: solid and hematological malignancies.
 Results: One hundred eight of 140 patients were diagnosed with solid organ malignancy and 32 with hematological malignancy. The most common comorbidity was found to be hypertension. A total of 94 patients died during their ICU stay. While the most common solid organ malignancies were malignancies of the lower gastrointestinal tract and lung cancers, multiple myeloma (MM) was the most common hematological malignancy. There was no significant difference between the two groups in terms of cytokine storm scores , duration of hospitalization and mechanical ventilation. Levels of Ferritin and LDH were found to be significantly higher in patients with hematological malignancies, while D-dimer was significantly higher in solid organ malignancies. A high level of CRP and IL-6 was associated with COVID-19 mortality. Lymphopenia was associated with increased mortality in patients with solid organ malignancy. However, there was no difference in mortality rate among both groups. Although the mortality was significantly higher in the patient group receiving chemotherapy, there were no significant differences in mortality for the duration of receiving chemotherapy.
 Conclusion: The results of this study suggested that cancer was associated with severe clinical outcomes and a 67% mortality rate among patients with COVID-19. However, despite the changes in patients’ demographic, clinical and laboratory characteristics, no difference in mortality rate was detected in patients with hematological and solid organ malignancies due to COVID-19 infection.