Clinical course of Coronavirus Disease-19 in patients with haematological malignancies is characterized by a longer time to respiratory deterioration compared to non-haematological ones: results from a case-control study

A Oliva; A Curtolo; L Volpicelli; F Cancelli; C Borrazzo; F Cogliati Dezza; G Marcelli; F Gavaruzzi; S Di Bari; P Ricci; O Turriziani; C M Mastroianni; M Venditti

doi:10.1007/s15010-022-01869-w

Clinical course of Coronavirus Disease-19 in patients with haematological malignancies is characterized by a longer time to respiratory deterioration compared to non-haematological ones: results from a case-control study

Infection. 2022 Oct;50(5):1373-1382. doi: 10.1007/s15010-022-01869-w. Epub 2022 Jul 3.

Authors

A Oliva¹, A Curtolo², L Volpicelli², F Cancelli², C Borrazzo³, F Cogliati Dezza², G Marcelli⁴, F Gavaruzzi², S Di Bari², P Ricci⁴, O Turriziani⁵, C M Mastroianni², M Venditti²

Affiliations

¹ Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 500185, Rome, Italy. alessandra.oliva@uniroma1.it.
² Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 500185, Rome, Italy.
³ Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.
⁴ Unit of Emergency Radiology, Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
⁵ Microbiology and Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.

Abstract

Background: We evaluated clinical features and risk factors for mortality in patients with haematological malignancies and COVID-19.

Methods: Retrospective, case-control (1:3) study in hospitalized patients with COVID-19. Cases were patients with haematological malignancies and COVID-19, controls had COVID-19 without haematological malignancies. Patients were matched for sex, age and time of hospitalization.

Results: Overall, 66 cases and 198 controls were included in the study. Cases had higher prior corticosteroid use, infection rates, thrombocytopenia and neutropenia and more likely received corticosteroids and antibiotics than controls. Cases had higher respiratory deterioration than controls (78.7% vs 65.5%, p = 0.04). Notably, 29% of cases developed respiratory worsening > 10 days after hospital admission, compared to only 5% in controls. Intensive Care Unit admission and mortality were higher in cases than in controls (27% vs 8%, p = 0.002, and 35% vs 10%, p < 0.001). At multivariable analysis, having haematological malignancy [OR4.76, p < 0.001], chronic corticosteroid therapy [OR3.65, p = 0.004], prior infections [OR57.7, p = 0.006], thrombocytopenia [OR3.03, p < 0.001] and neutropenia [OR31.1, p = 0.001], low albumin levels [OR3.1, p = 0.001] and ≥ 10 days from hospital admission to respiratory worsening [OR3.3, p = 0.002] were independently associated with mortality. In cases, neutropenia [OR3.1, p < 0.001], prior infections [OR7.7, p < 0.001], ≥ 10 days to respiratory worsening [OR4.1, p < 0.001], multiple myeloma [OR1.5, p = 0.044], the variation of the CT lung score during hospitalization [OR2.6, p = 0.006] and active treatment [OR 4.4, p < 0.001] all were associated with a worse outcome.

Conclusion: An underlying haematological malignancy was associated with a worse clinical outcome in COVID-19 patients. A prolonged clinical monitoring is needed, since respiratory worsening may occur later during hospitalization.

Keywords: COVID-19; Haematological malignancy; Multiple myeloma; Non-Hodgkin lymphoma; SARS-CoV2.

MeSH terms

Adrenal Cortex Hormones / therapeutic use
Albumins
Anti-Bacterial Agents
COVID-19* / epidemiology
Case-Control Studies
Hematologic Neoplasms* / complications
Humans
Neutropenia* / complications
Retrospective Studies
SARS-CoV-2
Thrombocytopenia* / complications

Substances

Adrenal Cortex Hormones
Albumins
Anti-Bacterial Agents