National Medical Research Center for Hematology, Moscow, Russia.
RakFond, Moscow, Russia.
Clin Lymphoma Myeloma Leuk. 2023 Aug;23(8):589-598. doi: 10.1016/j.clml.2023.04.002. Epub 2023 Apr 14.
Patients with hematologic diseases are at higher risk of the SARS-CoV-2 infection and more severe clinical outcomes of the coronavirus disease. CHRONOS19 is an observational prospective cohort study with the aim to determine the short and longer-term clinical outcomes, risk factors for disease severity and mortality, and rates of postinfectious immunity in patients with malignant and nonmalignant hematologic diseases and COVID-19.
Overall, 666 patients were enrolled in the study, of which 626 were included in the final data analysis. The primary endpoint was 30-days all-cause mortality. Secondary endpoints included COVID-19 complications, rates of ICU admission and mechanical ventilation, outcomes of a hematologic disease in SARS-CoV-2 infected patients, overall survival, and risk factors for disease severity and mortality. Data from 15 centers were collected at 30, 90, and 180 days after COVID-19 was diagnosed and were managed using a web-based e-data capture platform. All evaluations were performed in the pre-omicron period of COVID-19 pandemic.
Thirty-days all-cause mortality was 18.9%. The predominant cause of death (in 80% of cases) were COVID-19 complications. At 180 days, the majority (70%) of additional deaths were due to hematologic disease progression. At a median follow-up of 5.7 [0.03-19.04] months, 6-months overall survival was 72% [95% CI: 0.69-0.76]. One-third of patients had severe SARS-CoV-2 disease. The rate of ICU admission was 22% with 77% of these patients requiring mechanical ventilation, with poor survival rate. A univariate analysis revealed that older age (≥ 60 years), male sex, malignant hematologic disease, myelotoxic agranulocytosis, transfusion dependence, refractory disease or relapse, diabetes among comorbidities, any complications, especially ARDS alone or in combination with CRS, admission to an ICU, and mechanical ventilation were associated with higher risks of mortality. Treatment of the hematologic disease was changed, postponed, or canceled in 63% of patients. At a longer follow-up (90 and 180 days), the status of the hematologic disease changed in 7.5% of patients.
Patients with hematologic disease and COVID-19 have high mortality rates, predominantly due to COVID-19 complications. At a longer-term follow-up, no significant impact of COVID-19 on the course of a hematologic disease was revealed.
患有血液疾病的患者感染 SARS-CoV-2 的风险更高，并且冠状病毒疾病的临床结局更严重。CHRONOS19 是一项观察性前瞻性队列研究，旨在确定恶性和非恶性血液疾病和 COVID-19 患者的短期和长期临床结局、疾病严重程度和死亡率的危险因素，以及感染后获得的免疫能力。
共有 666 名患者入组该研究，其中 626 名患者纳入最终数据分析。主要终点为 30 天全因死亡率。次要终点包括 COVID-19 并发症、入住重症监护病房和机械通气的比例、SARS-CoV-2 感染患者血液疾病的结局、总生存率，以及疾病严重程度和死亡率的危险因素。在 COVID-19 确诊后 30、90 和 180 天，从 15 个中心收集数据，并使用基于网络的电子数据采集平台进行管理。所有评估均在 COVID-19 大流行的 omicron 前时期进行。
30 天全因死亡率为 18.9%。主要死亡原因（80%的病例）是 COVID-19 并发症。180 天时，大多数（70%）额外死亡是由于血液疾病进展。在中位随访 5.7[0.03-19.04]个月时，6 个月总生存率为 72%[95%CI：0.69-0.76]。三分之一的患者患有严重的 SARS-CoV-2 疾病。入住重症监护病房的比例为 22%，其中 77%的患者需要机械通气，生存率较低。单因素分析显示，年龄较大（≥60 岁）、男性、恶性血液疾病、骨髓毒性粒细胞减少症、依赖输血、难治性疾病或复发、合并症中的糖尿病、任何并发症，特别是 ARDS 单独或与 CRS 一起、入住重症监护病房和机械通气与更高的死亡率相关。63%的患者改变了血液疾病的治疗、推迟或取消了治疗。在更长的随访（90 和 180 天）中，7.5%的患者血液疾病状况发生了变化。
患有血液疾病和 COVID-19 的患者死亡率较高，主要原因是 COVID-19 并发症。在更长的随访中，COVID-19 对血液疾病病程没有明显影响。
