Clinical Hematology Department, Institut Català d'Oncologia-Hospital Duran i Reynals, Barcelona, Spain.
Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.
Cancer Rep (Hoboken). 2021 Aug;4(4):e1358. doi: 10.1002/cnr2.1358. Epub 2021 Mar 3.
Clinical outcomes of novel coronavirus 2019 disease (COVID-19) in onco-hematological patients are unknown. When compared to non-immunocompromised patients, onco-hematological patients seem to have higher mortality rates.
We describe the characteristics and outcomes of a consecutive cohort of 24 onco-hematological patients with COVID-19 during the first month of the pandemic. We also describe variations in healthcare resource utilization within our hematology department.
Data from patients between the first month of the pandemic were retrospectively collected. Clinical and logistic data were also collected and compared with the average values from the prior 3 months of activity. Prevalence of COVID-19 in our hematological population was 0.4%. Baseline characteristics were as follows: male sex: 83%, lymphoid diseases: 46%, median age: 69 (22-82) years. Median follow-up in survivors was 14 (9-28) days and inpatient mortality rate was 46%. Average time to moderate/severe respiratory insufficiency and death were 3 (1-10) and 10 (3-18) days, respectively. Only 1 out of every 12 patients who developed moderate to severe respiratory insufficiency recovered. Upon univariate analysis, the following factors were associated with higher mortality: age ≥ 70 years (P = .01) and D-dimer ≥900 mcg/L (P = .04). With respect to indirect effects during the COVID-19 pandemic, and when compared with the prior 3 months of activity, inpatient mortality (excluding patients with COVID-19 included in the study) increased by 56%. This was associated with a more frequent use of vasoactive drugs (+300%) and advanced respiratory support (+133%) in the hematology ward. In the outpatient setting, there was a reduction in initial visits (-55%) and chemotherapy sessions (-19%). A significant increase in phone visits was reported (+581%).
COVID-19 pandemic is associated with elevated mortality in hematological patients. Negative indirect effects are also evident within this setting.
新型冠状病毒 2019 疾病（COVID-19）在肿瘤血液病患者中的临床结果尚不清楚。与非免疫功能低下的患者相比，肿瘤血液病患者的死亡率似乎更高。
我们描述了在大流行的第一个月内连续收治的 24 例 COVID-19 肿瘤血液病患者的特征和结局。我们还描述了血液科内医疗资源利用的变化。
回顾性收集了大流行第一个月期间患者的数据。还收集了临床和逻辑数据，并与前 3 个月活动的平均值进行了比较。COVID-19 在我们血液学人群中的患病率为 0.4%。基线特征如下：男性：83%，淋巴细胞疾病：46%，中位年龄：69（22-82）岁。幸存者的中位随访时间为 14（9-28）天，住院死亡率为 46%。平均达到中度/重度呼吸功能不全和死亡的时间分别为 3（1-10）和 10（3-18）天。只有 1/12 出现中度至重度呼吸功能不全的患者得到恢复。单因素分析显示，以下因素与死亡率升高相关：年龄≥70 岁（P=0.01）和 D-二聚体≥900 mcg/L（P=0.04）。关于 COVID-19 大流行期间的间接影响，与前 3 个月的活动相比，住院死亡率（不包括纳入本研究的 COVID-19 患者）增加了 56%。这与血液科病房中血管活性药物（增加 300%）和高级呼吸支持（增加 133%）的使用更为频繁有关。在门诊环境中，初始就诊（减少 55%）和化疗（减少 19%）减少。报告称电话咨询显著增加（增加 581%）。
COVID-19 大流行与血液病患者死亡率升高有关。在这种情况下，还存在负面的间接影响。
