COVID-19 给血液系统恶性肿瘤成年患者带来的负担：大规模 SARS-CoV-2 疫苗接种计划实施后的单中心经验。
The Burden of COVID-19 in Adult Patients With Hematological Malignancies: A Single-center Experience After the Implementation of Mass-vaccination Programs Against SARS-CoV-2.
机构信息
Third Department of Internal Medicine, School of Medicine, National & Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece;
Third Department of Internal Medicine, School of Medicine, National & Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece.
出版信息
In Vivo. 2023 Nov-Dec;37(6):2743-2754. doi: 10.21873/invivo.13385.
BACKGROUND/AIM: Despite the widespread mass-vaccination programs worldwide and the continuing evolution of COVID-19 therapeutics, the burden of SARS-CoV-2 infection in patients with hematological malignancies (HM) remains elusive. The aim of the present study was to assess the clinical characteristics, outcomes and therapeutic strategies applied in HM patients hospitalized during the post-vaccine period in Greece.
PATIENTS AND METHODS
From June 2021 to October 2022, 60 HM patients with COVID-19 were retrospectively analyzed. Exploratory end-points included the incidence of intubation, probability of recovery, mortality, and duration of remdesivir (RDV) administration.
RESULTS
Overall, mechanical ventilation (MV) was required for five patients and crude mortality was 8.3%. HM of lymphocytic origin (p=0.035) and obesity (p=0.03) were the main determinants of the risk of intubation and among several laboratory markers, only LDH>520 IU/l was proven to be an independent MV predictor (p=0.038). The number of co-existing comorbidities (p=0.05) and disease severity on admission (p<0.001) were found to rule the probability of recovery, and dexamethasone was associated with worse prognosis, particularly in patients with mild/moderate COVID-19. RDV was administered to the entire cohort, of whom 38 were managed with an extended course. In the multivariate analysis, patients with HM of lymphocytic origin were more likely to receive RDV for more than five days (p=0.002).
CONCLUSION
Our study emphasizes the frailty of HM patients, even in the era of Omicron-variant predominance, and underlines the need to optimize therapy.
背景/目的：尽管全球范围内广泛开展了大规模疫苗接种计划，并且 COVID-19 的治疗方法也在不断发展，但血液病患者（HM）中 SARS-CoV-2 感染的负担仍难以确定。本研究旨在评估希腊在疫苗接种后时期住院的 HM 患者的临床特征、结局和应用的治疗策略。
患者和方法
从 2021 年 6 月至 2022 年 10 月，回顾性分析了 60 例 HM 合并 COVID-19 的患者。探索性终点包括插管率、康复概率、死亡率和瑞德西韦（RDV）的给药时间。
结果
总体而言，有 5 例患者需要机械通气（MV），粗死亡率为 8.3%。淋巴造血系统 HM（p=0.035）和肥胖（p=0.03）是插管风险的主要决定因素，在几个实验室标志物中，只有 LDH>520 IU/l 被证明是独立的 MV 预测因素（p=0.038）。共存的合并症数量（p=0.05）和入院时疾病严重程度（p<0.001）被认为与康复概率有关，地塞米松与较差的预后相关，尤其是在 COVID-19 轻症/中症患者中。RDV 被应用于整个队列，其中 38 例患者接受了延长疗程。在多变量分析中，淋巴造血系统 HM 患者更有可能接受超过五天的 RDV 治疗（p=0.002）。
结论
我们的研究强调了 HM 患者的脆弱性，即使在奥密克戎变异为主导的时代也是如此，并强调了优化治疗的必要性。
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