Urgent Care Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
Cancer Invest. 2022 Jan;40(1):17-25. doi: 10.1080/07357907.2021.1985134. Epub 2021 Oct 28.
Our goal was to identify discrete clinical characteristics associated with safe discharge from an emergency department/urgent care for patients with a history of cancer and concurrent COVID-19 infection during the SARS-CoV-2 pandemic and prior to widespread vaccination.
We retrospectively analyzed 255 adult patients with a history of cancer who presented to Memorial Sloan Kettering Cancer Center (MSKCC) urgent care center (UCC) from March 1, 2020 to May 31, 2020 with concurrent COVID-19 infection. We evaluated associations between patient characteristics and 30-day mortality from initial emergency department (ED) or urgent care center (UCC) visit and the absence of a severe event within 30 days. External validation was performed on a retrospective data from 29 patients followed at Fred Hutchinson Cancer Research Center that presented to the local emergency department. A late cohort of 108 additional patients at MSKCC from June 1, 2020 to January 31, 2021 was utilized for further validation.
In the MSKCC cohort, 30-day mortality and severe event rate was 15% and 32% respectively. Using stepwise regression analysis, elevated BUN and glucose, anemia, and tachypnea were selected as the main predictors of 30-day mortality. Conversely, normal albumin, BUN, calcium, and glucose, neutrophil-lymphocyte ratio <3, lack of (severe) hypoxia, lack of bradycardia or tachypnea, and negative imaging were selected as the main predictors of an uneventful course as defined as a Lack Of a Severe Event within Thirty Days (LOSETD). Utilizing this information, we devised a tool to predict 30-day mortality and LOSETD which achieved an area under the operating curve (AUC) of 79% and 74% respectively. Similar estimates of AUC were obtained in an external validation cohort. A late cohort at MSKCC was consistent with the prior, albeit with a lower AUC.
We identified easily obtainable variables that predict 30-day mortality and the absence of a severe event for patients with a history of cancer and concurrent COVID-19. This has been translated into a bedside tool that the clinician may utilize to assist disposition of this group of patients from the emergency department or urgent care setting.
我们的目标是确定与 2020 年 SARS-CoV-2 大流行期间和广泛疫苗接种前患有癌症病史和并发 COVID-19 感染的患者从急诊科/紧急护理中心安全出院相关的离散临床特征。
我们回顾性分析了 2020 年 3 月 1 日至 2020 年 5 月 31 日期间在纪念斯隆凯特琳癌症中心（MSKCC）急诊中心就诊的 255 名患有癌症病史的成年患者，这些患者同时患有 COVID-19 感染。我们评估了患者特征与初始急诊科（ED）或紧急护理中心（UCC）就诊 30 天内死亡率以及 30 天内无严重事件之间的关系。对弗雷德哈钦森癌症研究中心的 29 名患者的回顾性数据进行了外部验证，这些患者在当地急诊科就诊。MSKCC 的晚期队列包括 2020 年 6 月 1 日至 2021 年 1 月 31 日的另外 108 名患者，用于进一步验证。
在 MSKCC 队列中，30 天死亡率和严重事件发生率分别为 15%和 32%。使用逐步回归分析，选择升高的 BUN 和血糖、贫血和呼吸急促作为 30 天死亡率的主要预测因素。相反，白蛋白、BUN、钙和血糖正常、中性粒细胞与淋巴细胞比值<3、无（严重）低氧血症、无心动过缓或呼吸急促、影像学检查阴性被选为无不良事件过程的主要预测因素，定义为 30 天内无严重事件（LOSETD）。利用这些信息，我们设计了一种预测 30 天死亡率和 LOSETD 的工具，其获得的曲线下面积（AUC）分别为 79%和 74%。在外部验证队列中也获得了类似的 AUC 估计值。MSKCC 的晚期队列与之前的队列一致，尽管 AUC 较低。
我们确定了一些易于获得的变量，这些变量可以预测患有癌症病史和并发 COVID-19 的患者的 30 天死亡率和无严重事件。这已转化为一种床边工具，临床医生可以在急诊科或紧急护理环境中使用该工具来协助处理这群患者。
