Clinical Characteristics and Outcomes in Hospitalized Patients with COVID-19 and Cancer History: A Multicenter Cross-Sectional Study in Southwestern Iran
-
Javad Zarei
,
Abbas Sheikhtaheri
,
Mehrnaz ahmadi
,
Maria Cheraghi
,
Abdolhassan Talaiezadeh
,
Adeleh Khazami
Abstract
Background: Cancer patients are more exposed to opportunistic infections, such as COVID-19, due to their poor health status. This study aimed to identify the clinical characteristics of cancer and non-cancer patients with COVID-19 that may lead to death, intubation, and ICU admission.
Materials and Methods: A Multicenter Cross-Sectional study was conducted on confirmed COVID-19 adult patients with and without a history of cancer from March 2019 to March 2021. Demographic and clinical features, ICU admission, intubation, and discharge status have been extracted from patients’ medical records. Chi-square, odds ratio, Mann-Whitney test, and logistic regression were used to analyze the data.
Results: The death rate in 1332 cancer patients was 28% compared to the 91464 noncancer patients which was 9% with an odds ratio of 3.94 and p<0.001. ICU admission rates among the cancer group were 43%, while in the noncancer group, it was 17.9% (p<0.001). Moreover, intubation was done for 20.9% of cancer patients and 7.4% of non-cancer patients (p<0.001). However, no significant difference was observed between the two groups in terms of length of stay in the hospital. Multivariable logistic regression analysis showed that age, level of consciousness, SPO2, and autoimmune disorders were associated with mortality in cancer patients with COVID-19.
Conclusion: This study showed that older age, loss of consciousness, low oxygen saturation, and suffering from autoimmune disorders were the predictors of death in cancer patients with COVID-19. These results can have important implications for the management and care of cancer patients with COVID-19.
. World Health Organization. WHO Coronavirus (COVID-19) Dashboard: WHO; 2023 [cited 2023 April 26]. Available from: https://covid19.who.int.
2. Samaranayake L, Fakhruddin KS. SARS-CoV-2 variants and COVID-19: an overview. Dent Update. 2021;48(3):235-8.
3. Darby AC, Hiscox JA. Covid-19: variants and vaccination. BMJ. 2021;372:n771.
4. COVID-19 Coronavirus Pandemic, live update: Worldometer; 2023 [cited 2023 April 26]. Available from: https://www.worldometers.info/coronavirus.
5. Parohan M, Yaghoubi S, Seraji A, et al. Risk factors for mortality in patients with Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of observational studies. Aging Male. 2020;23(5):1416-24.
6. Tian W, Jiang W, Yao J, et al. Predictors of mortality in hospitalized COVID-19 patients: A systematic review and meta-analysis. J Med Virol. 2020;92(10):1875-83.
7. Meng Y, Lu W, Guo E, et al. Cancer history is an independent risk factor for mortality in hospitalized COVID-19 patients: a propensity score-matched analysis. J Hematol Oncol. 2020;13(1):75.
8. Yang K, Sheng Y, Huang C, et al. Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study. Lancet Oncol. 2020;21(7):904-13.
9. Rogado J, Obispo B, Pangua C, et al. Covid-19 transmission, outcome and associated risk factors in cancer patients at the first month of the pandemic in a Spanish hospital in Madrid. Clin Transl Oncol. 2020;22(12):2364-8.
10. Li Q, Chen L, Li Q, et al. Cancer increases risk of in-hospital death from COVID-19 in persons <65 years and those not in complete remission. Leukemia. 2020;34(9):2384-91.
11. Sorouri M, Kasaeian A, Mojtabavi H, et al. Clinical characteristics, outcomes, and risk factors for mortality in hospitalized patients with COVID-19 and cancer history: a propensity score-matched study. Infect Agent Cancer. 2020;15(1):74.
12. Shahidsales S, Aledavood SA, Joudi M, et al. COVID-19 in cancer patients may be presented by atypical symptoms and higher mortality rate, a case-controlled study from Iran. Cancer Rep (Hoboken). 2021;4(5):e1378.
13. Allegra A, Pioggia G, Tonacci A, et al. Cancer and SARS-CoV-2 Infection: Diagnostic and Therapeutic Challenges. Cancers (Basel). 2020;12(6):1581.
14. Lee AJX, Purshouse K. COVID-19 and cancer registries: learning from the first peak of the SARS-CoV-2 pandemic. Br J Cancer. 2021;124(11):1777-84.
15. Asokan I, Rabadia SV, Yang EH. The COVID-19 Pandemic and its Impact on the Cardio-Oncology Population. Curr Oncol Rep. 2020;22(6):60.
16. Taghizadeh-Hesary F, Porouhan P, Soroosh D, et al. COVID-19 in Cancer and Non-cancer Patients. Int J Cancer Manag. 2021;14(4):e110907.
17. Safari M, Faradmal J, Bashirian S, et al. Identifying the Risk Factors for Mortality in Patients with Cancer and COVID-19 in Hamadan, the West of Iran. J Gastrointest Cancer. 2022;53(3):614-22.
18. Tian J, Yuan X, Xiao J, et al. Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study. Lancet Oncol. 2020;21(7):893-903.
19. Zarei J, Dastoorpoor M, Jamshidnezhad A, et al. Regional COVID-19 registry in Khuzestan, Iran: A study protocol and lessons learned from a pilot implementation. Inform Med Unlocked. 2021;23:100520.
20. Zarei J, Badavi M, Karandish M, et al. A study to design minimum data set of COVID-19 registry system. BMC Infect Dis. 2021;21(1):773.
21. Ruiz R, Morante Z, Namuche F, et al. Clinical characteristics and outcomes in cancer patients affected by COVID-19: a study from a Peruvian cancer center. Onkoresearch. 2022;1(1):5-13.
22. Arman A, Tajik M, Nazemipour M, et al. Risk factors of developing critical conditions in Iranian patients with COVID-19. Glob Epidemiol. 2021;3:100046.
23. Batra A, Kalyani CV, Rohilla KK. Incidence and severity of self-reported chemotherapy side-effects in patients with hematolymphoid malignancies: A cross-sectional study. Cancer Res Stat Treat. 2020;3(4):736-741.
24. Zhou J, Lakhani I, Chou O, et al. Clinical characteristics, risk factors and outcomes of cancer patients with COVID-19: A population-based study. Cancer Med. 2023;12(1):287-96.
25. Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55(5):2000547.
26. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.
27. Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43.
28. Garassino MC, Whisenant JG, Huang LC, et al. COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study. Lancet Oncol. 2020;21(7):914-22.
29. Lee LYW, Cazier JB, Angelis V, et al. COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study. Lancet. 2020;395(10241):1919-26.
30. Jdiaa SS, Mansour R, El Alayli A, et al. COVID–19 and chronic kidney disease: an updated overview of reviews. J Nephrol. 2022;35(1):69-85.
31. Mamlouk O, Turin A, D'Achiardi D, et al. Clinical characteristics and outcomes of cancer patients with chronic kidney disease and coronavirus disease 2019. J Clin Oncol. 2021;39(15_suppl):e18815-e.
32. Carreira H, Strongman H, Peppa M, et al. Prevalence of COVID-19-related risk factors and risk of severe influenza outcomes in cancer survivors: a matched cohort study using linked English electronic health records data. EClinicalMedicine. 2020;29-30:100656.
33. Park HY, Kang D, Shin SH, et al. Chronic obstructive pulmonary disease and lung cancer incidence in never smokers: a cohort study. Thorax. 2020;75(6):506-9.
34. Denholm R, Schüz J, Straif K, et al. Is previous respiratory disease a risk factor for lung cancer? Am J Respir Crit Care Med. 2014;190(5):549-59.
35. Salehiniya H, Bahadori M, Ghanizadeh G, et al. Epidemiological Study of Lung Cancer in Iran: A Systematic Review. Iran J Public Health. 2022;51(2):306-17.
36. Giat E, Ehrenfeld M, Shoenfeld Y. Cancer and autoimmune diseases. Autoimmun Rev. 2017;16(10):1049-57.
37. Tsuzuki S, Takahashi H, Chen F, et al. AB0354 can cancer trigger autoimmunity disease? features of autoimmune disorder of cancer patients. Ann Rheum Dis. 2019;78(Suppl 2):1633.
38. Akiyama S, Hamdeh S, Micic D, et al. Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis. Ann Rheum Dis. 2021;80(3):384-91.
39. Dreyer N, Petruski-Ivleva N, Albert L, et al. Identification of a Vulnerable Group for Post-Acute Sequelae of SARS-CoV-2 (PASC): People with Autoimmune Diseases Recover More Slowly from COVID-19. Int J Gen Med. 2021;14:3941-9.
40. Asghar MS, Yasmin F, Babar MS, et al. Clinical characteristics and outcomes of cancer patients and their hospital course during the COVID-19 pandemic in a developing country. Ann Med Surg (Lond). 2022;74:103284.
41. Zhang H, Han H, He T, et al. Clinical Characteristics and Outcomes of COVID-19–Infected Cancer Patients: A Systematic Review and Meta-Analysis. J Natl Cancer Inst. 2021;113(4):371-380.
2. Samaranayake L, Fakhruddin KS. SARS-CoV-2 variants and COVID-19: an overview. Dent Update. 2021;48(3):235-8.
3. Darby AC, Hiscox JA. Covid-19: variants and vaccination. BMJ. 2021;372:n771.
4. COVID-19 Coronavirus Pandemic, live update: Worldometer; 2023 [cited 2023 April 26]. Available from: https://www.worldometers.info/coronavirus.
5. Parohan M, Yaghoubi S, Seraji A, et al. Risk factors for mortality in patients with Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of observational studies. Aging Male. 2020;23(5):1416-24.
6. Tian W, Jiang W, Yao J, et al. Predictors of mortality in hospitalized COVID-19 patients: A systematic review and meta-analysis. J Med Virol. 2020;92(10):1875-83.
7. Meng Y, Lu W, Guo E, et al. Cancer history is an independent risk factor for mortality in hospitalized COVID-19 patients: a propensity score-matched analysis. J Hematol Oncol. 2020;13(1):75.
8. Yang K, Sheng Y, Huang C, et al. Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study. Lancet Oncol. 2020;21(7):904-13.
9. Rogado J, Obispo B, Pangua C, et al. Covid-19 transmission, outcome and associated risk factors in cancer patients at the first month of the pandemic in a Spanish hospital in Madrid. Clin Transl Oncol. 2020;22(12):2364-8.
10. Li Q, Chen L, Li Q, et al. Cancer increases risk of in-hospital death from COVID-19 in persons <65 years and those not in complete remission. Leukemia. 2020;34(9):2384-91.
11. Sorouri M, Kasaeian A, Mojtabavi H, et al. Clinical characteristics, outcomes, and risk factors for mortality in hospitalized patients with COVID-19 and cancer history: a propensity score-matched study. Infect Agent Cancer. 2020;15(1):74.
12. Shahidsales S, Aledavood SA, Joudi M, et al. COVID-19 in cancer patients may be presented by atypical symptoms and higher mortality rate, a case-controlled study from Iran. Cancer Rep (Hoboken). 2021;4(5):e1378.
13. Allegra A, Pioggia G, Tonacci A, et al. Cancer and SARS-CoV-2 Infection: Diagnostic and Therapeutic Challenges. Cancers (Basel). 2020;12(6):1581.
14. Lee AJX, Purshouse K. COVID-19 and cancer registries: learning from the first peak of the SARS-CoV-2 pandemic. Br J Cancer. 2021;124(11):1777-84.
15. Asokan I, Rabadia SV, Yang EH. The COVID-19 Pandemic and its Impact on the Cardio-Oncology Population. Curr Oncol Rep. 2020;22(6):60.
16. Taghizadeh-Hesary F, Porouhan P, Soroosh D, et al. COVID-19 in Cancer and Non-cancer Patients. Int J Cancer Manag. 2021;14(4):e110907.
17. Safari M, Faradmal J, Bashirian S, et al. Identifying the Risk Factors for Mortality in Patients with Cancer and COVID-19 in Hamadan, the West of Iran. J Gastrointest Cancer. 2022;53(3):614-22.
18. Tian J, Yuan X, Xiao J, et al. Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study. Lancet Oncol. 2020;21(7):893-903.
19. Zarei J, Dastoorpoor M, Jamshidnezhad A, et al. Regional COVID-19 registry in Khuzestan, Iran: A study protocol and lessons learned from a pilot implementation. Inform Med Unlocked. 2021;23:100520.
20. Zarei J, Badavi M, Karandish M, et al. A study to design minimum data set of COVID-19 registry system. BMC Infect Dis. 2021;21(1):773.
21. Ruiz R, Morante Z, Namuche F, et al. Clinical characteristics and outcomes in cancer patients affected by COVID-19: a study from a Peruvian cancer center. Onkoresearch. 2022;1(1):5-13.
22. Arman A, Tajik M, Nazemipour M, et al. Risk factors of developing critical conditions in Iranian patients with COVID-19. Glob Epidemiol. 2021;3:100046.
23. Batra A, Kalyani CV, Rohilla KK. Incidence and severity of self-reported chemotherapy side-effects in patients with hematolymphoid malignancies: A cross-sectional study. Cancer Res Stat Treat. 2020;3(4):736-741.
24. Zhou J, Lakhani I, Chou O, et al. Clinical characteristics, risk factors and outcomes of cancer patients with COVID-19: A population-based study. Cancer Med. 2023;12(1):287-96.
25. Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55(5):2000547.
26. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.
27. Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43.
28. Garassino MC, Whisenant JG, Huang LC, et al. COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study. Lancet Oncol. 2020;21(7):914-22.
29. Lee LYW, Cazier JB, Angelis V, et al. COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study. Lancet. 2020;395(10241):1919-26.
30. Jdiaa SS, Mansour R, El Alayli A, et al. COVID–19 and chronic kidney disease: an updated overview of reviews. J Nephrol. 2022;35(1):69-85.
31. Mamlouk O, Turin A, D'Achiardi D, et al. Clinical characteristics and outcomes of cancer patients with chronic kidney disease and coronavirus disease 2019. J Clin Oncol. 2021;39(15_suppl):e18815-e.
32. Carreira H, Strongman H, Peppa M, et al. Prevalence of COVID-19-related risk factors and risk of severe influenza outcomes in cancer survivors: a matched cohort study using linked English electronic health records data. EClinicalMedicine. 2020;29-30:100656.
33. Park HY, Kang D, Shin SH, et al. Chronic obstructive pulmonary disease and lung cancer incidence in never smokers: a cohort study. Thorax. 2020;75(6):506-9.
34. Denholm R, Schüz J, Straif K, et al. Is previous respiratory disease a risk factor for lung cancer? Am J Respir Crit Care Med. 2014;190(5):549-59.
35. Salehiniya H, Bahadori M, Ghanizadeh G, et al. Epidemiological Study of Lung Cancer in Iran: A Systematic Review. Iran J Public Health. 2022;51(2):306-17.
36. Giat E, Ehrenfeld M, Shoenfeld Y. Cancer and autoimmune diseases. Autoimmun Rev. 2017;16(10):1049-57.
37. Tsuzuki S, Takahashi H, Chen F, et al. AB0354 can cancer trigger autoimmunity disease? features of autoimmune disorder of cancer patients. Ann Rheum Dis. 2019;78(Suppl 2):1633.
38. Akiyama S, Hamdeh S, Micic D, et al. Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis. Ann Rheum Dis. 2021;80(3):384-91.
39. Dreyer N, Petruski-Ivleva N, Albert L, et al. Identification of a Vulnerable Group for Post-Acute Sequelae of SARS-CoV-2 (PASC): People with Autoimmune Diseases Recover More Slowly from COVID-19. Int J Gen Med. 2021;14:3941-9.
40. Asghar MS, Yasmin F, Babar MS, et al. Clinical characteristics and outcomes of cancer patients and their hospital course during the COVID-19 pandemic in a developing country. Ann Med Surg (Lond). 2022;74:103284.
41. Zhang H, Han H, He T, et al. Clinical Characteristics and Outcomes of COVID-19–Infected Cancer Patients: A Systematic Review and Meta-Analysis. J Natl Cancer Inst. 2021;113(4):371-380.
| Files | ||
| Issue | Vol 18, No 1 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijhoscr.v18i1.14744 | |
| Keywords | ||
| COVID-19; Cancer; Mortality; Prognostic Factors; Severe clinical events; Iran | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Zarei J, Sheikhtaheri A, ahmadi M, Cheraghi M, Talaiezadeh A, Khazami A. Clinical Characteristics and Outcomes in Hospitalized Patients with COVID-19 and Cancer History: A Multicenter Cross-Sectional Study in Southwestern Iran. Int J Hematol Oncol Stem Cell Res. 2024;18(1):53-63.
