Behiye Deniz KOSOVALI, İbrahim KOÇ, Gül Meral KOCABEYOĞLU, Berkay KÜÇÜK, Mehmet MUTLU

Yoğun bakımdaki COVID-19 malign ve nonCOVID-19 malign hastalarda mortalite farklı mıdır?

Amaç: Bu çalışmanın amacı, pandemi süresince COVID-19 ve non-COVID-19 yoğun bakım ünitelerinde (YBÜ) takip edilen malign hastaların demografik, klinik, laboratuvar özelliklerini ve mortalite oranlarını karşılaştırmaktır. Gereç ve Yöntemler: Bu çalışma 23 Mart 2020- 31 Ocak 2022 tarihleri arasında COVID-19 ve non-COVID-19 YBÜ’de yatan onkolojik tanılı hastaların dahil edildiği retrospektif gözlemsel çalışmadır. Erişkin (≥18 yaş), hematolojik ya da solid organ malignitesi olan hastalar çalışmaya alındı. Hastalar iki gruba ayrıldı: Birinci grup COVID-19 tanısı (Polimerase chain reaction (PCR) testi pozitif) ile COVID-19 YBÜ’ne kabul edilen, ikinci grup ise COVID-19 tanısı dışlanarak (PCR testi negatif ve klinik ve radyolojik olarak COVID-19 olmadığı doğrulanan) non-COVID-19 YBÜ’ne kabul edilen hastalar oluşturdu. İki grubun verileri karşılaştırıldı. Bulgular: Çalışmaya 150 COVID-19 ve malignitesi olan, 133 non-COVID-19 ve malignitesi olan toplam 283 hasta dahil edildi. İki grubun malignite özellikleri karşılaştırıldığında; COVID-19 grubunda malignitede kür sağlananlar anlamlı olarak fazlaydı. Solid organ malignitesi olanların oranları COVID-19 grubunda (%85,3), hematolojik malignitesi olanların oranı (%24,1) ise non-COVID-19 grubunda istatistiksel farkla daha fazlaydı (sırasıyla, p=0.04 ve 0.03). Ayrıca akciğer karsinomu (%22) COVID-19 grubunda istatistiksel olarak anlamlı olarak fazla idi. Tüm malign hastalarda mortalite prediktörü olarak; invaziv mekanik ventilatör (IMV) ihtiyacı, IMV kalış süresinde artış, nörolojik hastalığın eşlik etmesi ve vazopressör/inotrop ihtiyacı olarak belirlendi. Sonuç: COVID-19 malign hastalarda mortalite oranının non-COVID-19 malign hastalardan daha düşük olduğu, tüm malign hastalarda mortaliteye IMV gereksinimi ve süresi, vazopessör/inotrop ihtiyacı ve nörolojik hastalığın eşlik etmesinin etkili olduğu sonucuna varıldı. Mortalitenin non-COVID-19 hasta grubunda daha fazla olmasını malignitenin ileri evresi, klinik seyri, uygulanan immunsuprese tedavi (radyoterapi, kemoterapi gibi) gibi faktörlere bağlı olabileceğini düşünüyoruz.

Anahtar Kelimeler:

COVID-19, nonCOVID-19, malignite, onkolojik hastalar, mortalite, mortalite prediktörleri

The difference in mortality between COVID-19 and non-COVID-19 malign intensive care patients?

Aim: The aim of this study is to compare the demographic, clinical, laboratory characteristics and mortality rates of malignant patients followed in the COVID-19 and non-COVID-19 intensive care units (ICU) during the pandemic. Material and Methods: This is a retrospective observational study that included patients with oncological diagnosis of COVID-19 and non-COVID-19 hospitalized in the ICU between March 23, 2020 - January 31, 2022. Adult patients (≥18 years), with hematological or solid organ malignancy were included in this study. Patients were divided into two groups; first group admitted to ICU with the diagnosis of COVID-19 (polymerase chain reaction (PCR) test positive) and second gropu admitted to ICU without the diagnosis of COVID-19 (PCR test negative and clinically and radiologically confirmed that they were not COVID-19). Data of two groups were compared. Results: A total of 283 patients, 150 of whom had malignancies with COVID-19, and 133 patients with malignancies with non-COVID-19 were included in the study. When the malignancy characteristics of the two groups were compared; cured malignancy was significantly higher in the COVID-19 group. The rates of patients with solid organ malignancies were statistically higher in the COVID-19 group (85.3%), while those with hematological malignancies (24.1%) were statistically higher in the non-COVID-19 group (p=0.04 and 0.03, respectively). In addition, lung carcinoma (22%) was statistically significantly higher in the COVID-19 group. Predictors of mortality were invasive mechanical ventilator (IMV) requirement, duration of IMV, concomitant neurologic disease and need of vasopressor/inotrope. Conclusion: It was concluded that the mortality rate in COVID-19 malignant patients was lower than that of non-COVID-19 malignant patients, and that requirement and duration of IMV, the need of vasopessor/inotrope, and concomitant neurological disease were effective in mortality in all malignant patients. We think that the higher mortality in the nonCOVID-19 patient group may be due to factors such as end stage of the malignancy, clinical course, and immunosuppressive treatment (radiotherapy, chemotherapy, etc.).

Keywords:

COVID-19, non-COVID-19, malignancy, oncological patients, mortality, mortality predictors,

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1. Fu C, Stoeckle JH, Masri L et al. COVID-19 Outcomes in Hospitalized Patients With Active Cancer: Experiences From a Major New York City Health Care System. Cancer 2021; 7: 10.
2. Yang K, Sheng Y, Huang C et al. Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study. Lancet Oncol 2020; 21: 904–13
3. Sawyers A, Chou M, Johannet P et al. Clinical outcomes in cancer patients with COVID-19. Cancer Reports 2021; 4: 1413.
4. Zhang H, Han H, He T et al. Clinical Characteristics and Outcomes of COVID-19–Infected Cancer Patients: A Systematic Review and Meta-Analysis. JNCI J Natl Cancer Inst 2021; 113: 371-80.
5. Aboueshia M, Hussein MH, Attia AS et al. Cancer and COVID-19: analysis of patient Outcomes. Future Oncol. 10.2217/fon-2021-0121.
6. Lee LYW, Cazier JB, Starkey T et al. COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study. Lancet Oncol 2020; 21: 1309–16.
7. Díaz-Díaz D, Martínez MV, Herrejón EP et al. Oncological patients admitted to an intensive care unit. Analysis of predictors of inhospital mortality. Med Intensiva 2018; 42: 346-53.
8. De Jong A, Jung B, Jaber S. Intubation in the ICU: we could improve our practice. Critical Care 2014; 18: 209
9. Reyes LF, Rodriguez A, Bastidas A et al. Dexamethasone as riskfactor for ICU-acquired respiratory tract infections in severe COVID-19. Journal of Critical Care 2022; 69: 154014.
10. Sanyaolu A, Okorie C, Marinkovic A et al. Comorbidity and its Impact on Patients with COVID-19. SN Compr Clin Med 2020; 2: 1069–76.
11. Nadkarni AR, Vijayakumaran SC, Gupta S, Divatia JV. Mortality in Cancer Patients With COVID-19 Who Are Admitted to an ICU or Who Have Severe COVID-19: A Systematic Review and MetaAnalysis. JCO Global Oncol 2021; 7: 1286-305.
12. Plais H, Labruyère M, Creutin T et al. Outcomes of Patients With Active Cancer and COVID-19 in the Intensive-Care Unit: A Multicenter Ambispective Study. Front. Oncol. 2022; 12: 858276.
13. Shoumariyeh K, Biavasco F, Ihorst G et al. Covid-19 in patients with hematological and solid cancers at a Comprehensive Cancer Center in Germany. Cancer Medicine 2020; 9: 8412–22
14. Tavakolpour S, Rakhshandehroo T. Lymphopenia during the COVID-19 infection: What it shows and what can be learned. Immunol Lett 2020; 225: 31–2.
15. Lee J, Park SS, Kim TY, et al. Lymphopenia as a Biological Predictor of Outcomes in COVID-19 Patients: A Nationwide Cohort Study. Cancers (Basel) 2021; 13: 471.
16. Ahnach M, Zbiri S, Nejjari S et al. C-reactive protein as an early predictor of COVID-19 severity. J Med Biochem 2020; 39: 500-7.
17. Xu Y, Yang H, Wang J et al. Serum Albumin Levels are a Predictor of COVID-19 Patient Prognosis: Evidence from a Single Cohort in Chongqing, China. International Journal of General Medicine 2021; 14: 2785–97.
18. Turcato G, Zaboli A, Kostic I, et al. Severity of SARS-CoV-2 infection and albumin levels recorded at the first emergency department evaluation: a multicentre retrospective observational study. Emerg Med J 2022; 39:63–9.