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Title: Systemic pro-inflammatory response identifies patients with cancer with adverse outcomes from SARS-CoV-2 infection: the OnCovid Inflammatory Score
Author: Dettorre, Gino M.
Dolly, Saoirse
Loizidou, Angela
Chester, John
Jackson, Amanda
Mukherjee, Uma
Zambelli, Alberto
Aguilar Company, Juan
Bower, Mark
Sng, Christopher C. T.
Salazar Soler, Ramón
Bertuzzi, Alexia
Brunet, Joan
Mesia, Ricard
Sita-Lumsden, Ailsa
Seguí, Elia
Biello, Federica
Generali, Daniele
Grisanti, Salvatore
Seeva, Pavetha
Rizzo, Gianpiero
Libertini, Michela
Maconi, Antonio
Moss, Charlotte
Russell, Beth
Harbeck, Nadia
Vincenzi, Bruno
Bertulli, Rossella
Ottaviani, Diego
Liñan, Raquel
Marrari, Andrea
Carmona García, M. Carmen
Chopra, Neha
Tondini, Carlo Alberto
Mirallas, Oriol
Tovazzi, Valeria
Fotia, Vittoria
Cruz, Claudia Andrea
Saoudi González, Nadia
Felip, Eudald
Roqué, Ariadna
Lee, Alvin J. X.
Newsom-Davis, Tom
García Illescas, David
Reyes, Roxana
Wong, Yien Ning Sophia
Ferrante, Daniela
Scotti, Lorenza
Marco Hernández, Javier
Ruiz Camps, Isabel
Patriarca, Andrea
Rimassa, Lorenza
Chiudinelli, Lorenzo
Franchi, Michela
Santoro, Armando
Prat Aparicio, Aleix
Gennari, Alessandra
Van Hemelrijck, Mieke
Tabernero Caturla, Josep
Diamantis, Nikolaos
Pinato, David J.
OnCovid study group
Keywords: Càncer
Issue Date: 1-Mar-2021
Publisher: BMJ
Abstract: Background: Patients with cancer are particularly susceptible to SARS-CoV-2 infection. The systemic inflammatory response is a pathogenic mechanism shared by cancer progression and COVID-19. We investigated systemic inflammation as a driver of severity and mortality from COVID-19, evaluating the prognostic role of commonly used inflammatory indices in SARS-CoV-2-infected patients with cancer accrued to the OnCovid study. Methods: In a multicenter cohort of SARS-CoV-2-infected patients with cancer in Europe, we evaluated dynamic changes in neutrophil:lymphocyte ratio (NLR); platelet:lymphocyte ratio (PLR); Prognostic Nutritional Index (PNI), renamed the OnCovid Inflammatory Score (OIS); modified Glasgow Prognostic Score (mGPS); and Prognostic Index (PI) in relation to oncological and COVID-19 infection features, testing their prognostic potential in independent training (n=529) and validation (n=542) sets. Results: We evaluated 1071 eligible patients, of which 625 (58.3%) were men, and 420 were patients with malignancy in advanced stage (39.2%), most commonly genitourinary (n=216, 20.2%). 844 (78.8%) had ≥1 comorbidity and 754 (70.4%) had ≥1 COVID-19 complication. NLR, OIS, and mGPS worsened at COVID-19 diagnosis compared with pre-COVID-19 measurement (p<0.01), recovering in survivors to pre-COVID-19 levels. Patients in poorer risk categories for each index except the PLR exhibited higher mortality rates (p<0.001) and shorter median overall survival in the training and validation sets (p<0.01). Multivariable analyses revealed the OIS to be most independently predictive of survival (validation set HR 2.48, 95% CI 1.47 to 4.20, p=0.001; adjusted concordance index score 0.611). Conclusions: Systemic inflammation is a validated prognostic domain in SARS-CoV-2-infected patients with cancer and can be used as a bedside predictor of adverse outcome. Lymphocytopenia and hypoalbuminemia as computed by the OIS are independently predictive of severe COVID-19, supporting their use for risk stratification. Reversal of the COVID-19-induced proinflammatory state is a putative therapeutic strategy in patients with cancer.
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It is part of: Journal for ImmunoTherapy of Cancer, 2021, vol. 9, num. 3
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Appears in Collections:Articles publicats en revistes (Ciències Clíniques)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

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