Rudzite A M, Auzina D, Lejniece S
Riga Stradins University, Riga, Latvia.
Riga East University Hospital, Riga, Latvia
Exp Oncol. 2024 Dec 19;46(3):260-267. doi: 10.15407/exp-oncology.2024.03.260.
Patients with hematological malignancies (HM) are considered to have a high risk of developing severe and life-threatening infections including COVID-19 because of immune deficiency and immunosuppressive treatments. Although the COVID pandemic spread worldwide, morbidity and mortality data varied from country to country. A more accurate identification of risk factors would allow the improvement of the clinical management of HM patients.
This study aimed to determine real-life data - the mortality rate, clinical outcomes, and risk factors affecting mortality in patients with HM and COVID-19 at the Riga East University Hospital (REUH) in Latvia.
In this retrospective non-interventional cohort study, we included adult patients treated in REUH with ongoing HM and laboratory- confirmed COVID-19 observed between December 1st, 2020, and March 31st, 2023. All data were analyzed using descriptive statistics, binary logistic regression, univariable Cox regression model, and other methods.
We registered 156 patients with 11 different HMs. Multiple myeloma, non-Hodgkin lymphoma, and acute myeloid leukemia were the most common HM. COVID-19 mortality rate was 19.9% (31/156). Factors increasing the risk of death included the severity of COVID-19 (p < 0.001), the accession of bacterial infection (p < 0.001), longer hospital stay (p = 0.037), absolute neutrophil count (ANC) ≤ 0.5 × 109/mm3 (p = 0.014), fever (p = 0.039), and acute myeloid leukemia (p = 0.002). We also confirmed that the mortality in the third pandemic wave was significantly lower than in the second wave (p = 0.002). Although vaccination seemed to be a risk-mitigating factor (58.8% [10/17] of those who died from COVID-19 were not vaccinated), no statistically important correlation was found (p = 0.690).
This survey confirmed that the COVID-19 mortality rate was higher in patients with HM (19.9% [31/156]) than in the population. ANC, severity of COVID-19, accession of bacterial infection, hospital stay, fever, and acute myeloid leukemia were the factors that increased mortality in HM patients.
血液系统恶性肿瘤（HM）患者由于免疫缺陷和免疫抑制治疗，被认为发生包括2019冠状病毒病（COVID-19）在内的严重及危及生命感染的风险较高。尽管COVID疫情在全球蔓延，但各国的发病率和死亡率数据各不相同。更准确地识别风险因素将有助于改善HM患者的临床管理。
本研究旨在确定拉脱维亚里加东部大学医院（REUH）中HM合并COVID-19患者的实际数据——死亡率、临床结局以及影响死亡率的风险因素。
在这项回顾性非干预队列研究中，我们纳入了2020年12月1日至2023年3月31日期间在REUH接受治疗的患有持续性HM且实验室确诊为COVID-19的成年患者。所有数据均采用描述性统计、二元逻辑回归、单变量Cox回归模型及其他方法进行分析。
我们登记了156例患有11种不同血液系统恶性肿瘤的患者。多发性骨髓瘤、非霍奇金淋巴瘤和急性髓系白血病是最常见的血液系统恶性肿瘤。COVID-19死亡率为19.9%（31/156）。增加死亡风险的因素包括COVID-19的严重程度（p<0.001）、细菌感染的发生（p<0.001）、住院时间延长（p=0.037）、绝对中性粒细胞计数（ANC）≤0.5×10⁹/mm³（p=0.014）、发热（p=0.039）以及急性髓系白血病（p=0.002）。我们还证实，第三波疫情期间的死亡率显著低于第二波疫情期间（p=0.002）。尽管接种疫苗似乎是一个降低风险的因素（死于COVID-19的患者中有58.8%[10/17]未接种疫苗），但未发现统计学上的显著相关性（p=0.690）。
这项调查证实，HM患者的COVID-19死亡率（19.9%[31/156]）高于普通人群。ANC、COVID-19的严重程度、细菌感染的发生、住院时间、发热以及急性髓系白血病是增加HM患者死亡率的因素。
