Hematology Unit, ASST-Spedali Civili, Brescia, Italy.
University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
Int J Infect Dis. 2023 Dec;137:98-110. doi: 10.1016/j.ijid.2023.10.013. Epub 2023 Oct 18.
Elderly patients with hematologic malignancies face the highest risk of severe COVID-19 outcomes. The infection's impact on different age groups remains unstudied in detail.
We analyzed elderly patients (age groups: 65-70, 71-75, 76-80, and >80 years old) with hematologic malignancies included in the EPICOVIDEHA registry between January 2020 and July 2022. Univariable and multivariable Cox regression models were conducted to identify factors influencing death in COVID-19 patients with hematological malignancy.
The study included data from 3,603 elderly patients (aged 65 or older) with hematological malignancy, with a majority being male (58.1%) and a significant proportion having comorbidities. The patients were divided into four age groups, and the analysis assessed COVID-19 outcomes, vaccination status, and other variables in relation to age and pandemic waves. The 90-day survival rate for patients with COVID-19 was 71.2%, with significant differences between groups. The pandemic waves had varying impacts, with the first wave affecting patients over 80 years old, the second being more severe in 65-70, and the third being the least severe in all age groups. Factors contributing to 90-day mortality included age, comorbidities, lymphopenia, active malignancy, acute leukemia, less than three vaccine doses, severe COVID-19, and using only corticosteroids as treatment.
These data underscore the heterogeneity of elderly hematological patients, highlight the different impacts of COVID-19 waves and the pivotal importance of vaccination, and may help in planning future healthcare efforts.
患有血液系统恶性肿瘤的老年患者面临着 COVID-19 重症结局的最高风险。感染对不同年龄组的影响在细节上仍未得到充分研究。
我们分析了 2020 年 1 月至 2022 年 7 月期间 EPICOVIDEHA 登记处中年龄在 65-70 岁、71-75 岁、76-80 岁和>80 岁的老年血液系统恶性肿瘤患者。采用单变量和多变量 Cox 回归模型确定影响血液恶性肿瘤 COVID-19 患者死亡的因素。
该研究纳入了 3603 名年龄在 65 岁及以上的老年血液系统恶性肿瘤患者的数据，其中大多数为男性（58.1%），且相当一部分患者合并有合并症。患者被分为四个年龄组，分析评估了 COVID-19 结局、疫苗接种状态以及与年龄和大流行波次相关的其他变量。COVID-19 患者的 90 天生存率为 71.2%，不同组间存在显著差异。大流行波次的影响各有不同，第一波影响 80 岁以上的患者，第二波对 65-70 岁的患者影响更严重，第三波对所有年龄组的影响最小。导致 90 天死亡的因素包括年龄、合并症、淋巴细胞减少、活动性恶性肿瘤、急性白血病、接种疫苗不到三剂、COVID-19 重症以及仅使用皮质类固醇作为治疗。
这些数据突显了老年血液系统患者的异质性，强调了 COVID-19 波次的不同影响以及疫苗接种的重要性，可能有助于规划未来的医疗保健工作。
