血液恶性肿瘤患者 COVID-19 的临床表现及严重程度及其危险因素。

Clinical manifestations and risk factors for COVID-19 and its severity in patients with hematological malignancies.

机构信息

Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan.

出版信息

J Microbiol Immunol Infect. 2024 Jun;57(3):403-413. doi: 10.1016/j.jmii.2024.03.001. Epub 2024 Mar 8.

DOI:10.1016/j.jmii.2024.03.001

PMID:38480093

Abstract

BACKGROUND

Patients with hematological malignancies (HM) were at a high risk of developing severe disease from coronavirus disease 2019 (COVID-19). We aimed to assess the clinical outcome of COVID-19 in hospitalized patients with HM.

METHODS

Adult patients with HM who were hospitalized with a laboratory-confirmed COVID-19 between May, 2021 and November, 2022 were retrospectively identified. Primary outcome was respiratory failure requiring mechanical ventilation or mortality within 60 days after hospitalization. We also analyzed associated factors for de-isolation (defined as defervescence with a consecutive serial cycle threshold value > 30) within 28 days.

RESULTS

Of 152 eligible patients, 22 (14.5%) developed respiratory failure or mortality in 60 days. Factors associated with developing respiratory failure that required mechanical ventilation or mortality included receipt of allogeneic hematopoietic stem-cell transplantation (allo-HSCT) (adjusted hazards ratio [aHR], 5.10; 95% confidence interval [CI], 1.64-15.85), type 2 diabetes mellitus (aHR, 2.47; 95% CI, 1.04-5.90), lymphopenia at admission (aHR, 6.85; 95% CI, 2.45-19.15), and receiving <2 doses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines (aHR, 3.00; 95% CI, 1.19-7.60). Ninety-nine (65.1%) patients were de-isolated in 28 days, against which two hazardous factors were identified: receipt of B-cell depletion therapies within one year prior to COVID-19 (aHR, 0.55, 95% CI, 0.35-0.87) and lymphopenia upon admission (aHR, 0.65; 95% CI, 0.43-1.00).

CONCLUSION

We found a high rate of respiratory failure and mortality among patients with HM who contracted the SARS-CoV-2. Factors associated with developing respiratory failure or mortality in 60 days included receipt of allo-HSCT, type 2 diabetes mellitus and lymphopenia upon admission. Having received ≥2 doses of vaccination conferred protection against clinical progression.

摘要

背景

患有血液系统恶性肿瘤（HM）的患者因 2019 年冠状病毒病（COVID-19）而患严重疾病的风险较高。我们旨在评估住院 HM 患者 COVID-19 的临床结果。

方法

回顾性鉴定了 2021 年 5 月至 2022 年 11 月期间因实验室确诊 COVID-19 而住院的 HM 成年患者。主要结局是 60 天内需要机械通气或死亡的呼吸衰竭。我们还分析了 28 天内脱隔离（定义为连续循环阈值> 30 的退热）的相关因素。

结果

在 152 名符合条件的患者中，22 名（14.5%）在 60 天内发生呼吸衰竭或死亡。需要机械通气或死亡的呼吸衰竭相关因素包括接受异基因造血干细胞移植（allo-HSCT）（校正危害比[aHR]，5.10；95%置信区间[CI]，1.64-15.85）、2 型糖尿病（aHR，2.47；95%CI，1.04-5.90）、入院时淋巴细胞减少症（aHR，6.85；95%CI，2.45-19.15）和接受<2 剂严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）疫苗（aHR，3.00；95%CI，1.19-7.60）。99 名（65.1%）患者在 28 天内脱隔离，发现两个危险因素：COVID-19 前一年内接受 B 细胞耗竭治疗（aHR，0.55，95%CI，0.35-0.87）和入院时淋巴细胞减少症（aHR，0.65；95%CI，0.43-1.00）。