Higher mortality of hospitalized haematologic patients with COVID-19 compared to non-haematologic is driven by thrombotic complications and development of ARDS: An age-matched cohorts study. (January 2022)

• Record Type: Journal Article
• Authors: Fernández-Cruz, Ana; Puyuelo, Alba; Núñez Martín-Buitrago, Lucía; Sánchez-Chica, Enrique; Díaz-Pedroche, Carmen; Ayala, Rosa; Lizasoain, Manuel; Duarte, Rafael; Lumbreras, Carlos; Antonio Vargas, Juan
• Is Part Of: Clinical infection in practice. Volume 13(2022)
• Publication Date: 2022-01
• Subjects: COVID-19 -- Haematologic -- Outcome -- Mortality; ARDS acute respiratory distress syndrome -- C-RP C-reactive protein -- CI confidence interval -- CLL chronic lymphocytic leukemia -- COVID-19 Coronavirus disease 2019 -- DIC disseminated intravascular coagulation -- ECOG scale Eastern Cooperative Oncology Group scale -- G-CSF granulocyte stimulating factor -- HFNC high flow nasal cannula -- ICU Intensive Care Unit -- IL6 Interleukin 6 -- IQR interquartile range -- LDH Lactate dehydrogenase -- MDS myelodysplastic syndrome -- MM multiple myeloma -- MV mechanical ventilation -- NHL non-Hodgkin lymphoma -- NIMV non-invasive mechanical ventilation -- OR Odds ratio -- PaO2/FiO2 arterial oxygen tension/inspiratory oxygen fraction -- PEEP positive end expiratory pressure -- SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 -- SCT stem cell transplantation -- SD standard deviation; Communicable diseases -- Periodicals; Infection -- Periodicals; Communicable Diseases; Infections; Communicable diseases; Infection; Electronic journals; Periodical; Electronic journals; Periodicals; 616.905
• DOI: 10.1016/j.clinpr.2022.100137
• Languages: English
• ISSNs: 2590-1702

Abstract

Highlights: COVID-19 has worse outcomes in haematologic than in non-haematologic patients. Worse outcome of COVID-19 in haematologic patients is independent of age. The development of ARDS and thrombotic complications drive the higher in-hospital mortality. Abstract: Background and Objectives: The characteristics of COVID-19 in haematologic patients compared to non-haematologic patients have seldom been analyzed. Our aim was to analyze whether there are differences in clinical characteristics and outcome of haematologic patients with COVID-19 as compared to non-haematologic. Patients and methods: Retrospective cohort study in 2 University hospitals of patients admitted with laboratory-confirmed COVID-19 included in the SEMICOVID19 database. The cohort with underlying haematologic disease was compared to a cohort of age and date-of-COVID-19-matched controls without haematologic disease (1:2). Results: 71 cases and 142 controls were included from March-May 2020. Twenty (28.1%) had received recent chemotherapy. Twelve (16.9%) were stem cell transplant recipients (SCT). Eleven (15.5%) were neutropenic concurrently with COVID-19 diagnosis. Haematologic patients presented ARDS (58.5 vs 20.7%, p = 0.0001), thrombotic complications (15.7 vs 2.1%, p = 0.002), DIC (5.7 vs 0.0%, p = 0.011), heart failure (14.3 vs 4.9%, p = 0.029) and required ICU admission (15.5 vs 2.8%, p = 0.001), MV (14.1% vs 2.1%, p 0.001), steroid (64.8 vs 33.1%, p = 0.0001), tocilizumab (33.8 vs 8.5%, p = 0.0001) or anakinra treatment (9.9% vs 0%, p = 0.0001) more often. In-hospital mortality was significantly higher (38.0% vs 18.3%, p = 0.002). Conclusions: Our results suggest COVID-19 has worse outcomes in haematologic patients than in non-haematologic, independently of age, and that the development of ARDS and thrombotic complications drive the higher in-hospital mortality.