Dettorre, Gino M.Dolly, SaoirseLoizidou, AngelaChester, JohnJackson, AmandaMukherjee, UmaZambelli, AlbertoAguilar Company, JuanBower, MarkSng, Christopher C. T.Salazar Soler, RamónBertuzzi, AlexiaBrunet, JoanMesía Nin, RicardSita-Lumsden, AilsaSeguí, EliaBiello, FedericaGenerali, DanieleGrisanti, SalvatoreSeeva, PavethaRizzo, GianpieroLibertini, MichelaMaconi, AntonioMoss, CharlotteRussell, BethHarbeck, NadiaVincenzi, BrunoBertulli, RossellaOttaviani, DiegoLiñan, RaquelMarrari, AndreaCarmona García, M. CarmenChopra, NehaTondini, Carlo AlbertoMirallas, OriolTovazzi, ValeriaFotia, VittoriaCruz, Claudia AndreaSaoudi González, NadiaFelip, EudaldRoqué, AriadnaLee, Alvin J. X.Newsom-Davis, TomGarcía Illescas, DavidReyes, RoxanaWong, Yien Ning SophiaFerrante, DanielaScotti, LorenzaMarco Hernández, JavierRuiz, Isabel (Ruiz Camps)Patriarca, AndreaRimassa, LorenzaChiudinelli, LorenzoFranchi, MichelaSantoro, ArmandoPrat Aparicio, AleixGennari, AlessandraVan Hemelrijck, MiekeTabernero Caturla, JosepDiamantis, NikolaosPinato, David J.OnCovid study group2021-04-082021-04-082021-03-01https://hdl.handle.net/2445/176045Background: 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.13 p.application/pdfengcc by (c) Dettorre et al., 2021http://creativecommons.org/licenses/by/3.0/es/CàncerSARS-CoV-2COVID-19CancerSARS-CoV-2COVID-19info:eu-repo/semantics/article7174532021-04-08info:eu-repo/semantics/openAccess33753569