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Systemic pro-inflammatory response identifies patients with cancer with adverse outcomes from SARS-CoV-2 infection: the OnCovid Inflammatory Score

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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
Authors: Dettorre, G
Dolly, S
Loizidou, A
Chester, J
Jackson, A
Mukherjee, U
Zambelli, A
Aguilar-Company, J
Bower, M
Sng, CCT
Salazar, R
Bertuzzi, A
Brunet, J
Mesia, R
Sita-Lumsden, A
Segui, E
Biello, F
Generali, D
Grisanti, D
Seeva, P
Rizzo, G
Libertini, M
Maconi, A
Moss, C
Russell, B
Harbeck, N
Vincenzi, B
Bertulli, R
Ottaviani, D
Linan, R
Marrari, A
Carmona, C
Chopra, N
Tondini, C
Mirallas, O
Tovazzi, V
Fotia, V
Cruz, C
Saoudi-Gonzalez, N
Felip, E
Roque, A
Lee, AJX
Newsom-Davis, T
Garcia-Illescas, D
Reyes, R
Wong, YNS
Ferrante, D
Scotti, L
Marco, J
Ruiz Camps, I
Patriarca, A
Rimassa, L
Chiudinelli, L
Franchi, M
Santoro, A
Prat, A
Tabernero, J
Gennari, A
Van Hemelrijck, M
Diamantis, N
Pinato, D
Item Type: Journal Article
Abstract: Background: Cancer patients 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 utilized inflammatory indices in SARS-CoV-2-infected cancer patients accrued to the OnCovid study. Methods: In a multi-center cohort of SARS-CoV-2-infected cancer patients 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 relationship to oncological and Covid-19 infection features, testing their prognostic potential in independent training (n=529) and validation (n=542) sets. Results: We evaluated 1,071 eligible patients: 625 (58.3%) males, 420 with malignancy in advanced stage (39.2%), most commonly genitourinary (n=216, 20.2%). 844 (78.8%) had ≥1 comorbidity and 754 (70.4%) ≥1 Covid-19 complication. NLR, OIS, and mGPS worsened at Covid-19 diagnosis compared to 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 – 4.20, P=0.001; adjusted C-index 0.611). Conclusions: Systemic inflammation is a validated prognostic domain in SARS-CoV-2-infected cancer patients and can be utilized 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 pro-inflammatory state is a putative therapeutic strategy in patients with cancer.
Issue Date: 22-Mar-2021
Date of Acceptance: 5-Feb-2021
URI: http://hdl.handle.net/10044/1/86086
DOI: 10.1136/jitc-2020-002277
ISSN: 2051-1426
Publisher: BioMed Central
Start Page: 1
End Page: 13
Journal / Book Title: Journal for ImmunoTherapy of Cancer
Volume: 9
Issue: 3
Copyright Statement: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See https://creativecommons.org/licenses/by/4.0/.
Sponsor/Funder: Wellcome Trust
Funder's Grant Number: 204834/Z/16/Z
Keywords: Science & Technology
Life Sciences & Biomedicine
Oncology
Immunology
inflammation
inflammation mediators
COVID-19
COVID-19
inflammation
inflammation mediators
OnCovid study group
Publication Status: Published
Article Number: e002277
Online Publication Date: 2021-03-22
Appears in Collections:Department of Surgery and Cancer
Department of Infectious Diseases
Faculty of Medicine
Imperial College London COVID-19



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