COVID-19 and Cancer: Lessons Learnt from a Michigan Hotspot
Abstract
:1. Introduction
2. Results
2.1. Baseline Characteristics
2.1.1. COVID-19-Related Hospitalization
2.1.2. COVID-19-Directed Treatment
2.2. Primary Outcome (Death or Transition to Hospice) Amongst Hospitalized Patients
Impact of Socio-Demographic Factors on Primary Outcome in Hospitalized Patients
2.3. Secondary Outcomes
2.3.1. Aggressive Inpatient Care during COVID-19-Related Hospitalization
2.3.2. Length of Stay for Those Discharged after COVID-19-Related Hospitalization
3. Discussion
4. Materials and Methods
4.1. Study Design and Participants
4.2. Materials
4.3. Statistical Analysis
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Factors | All Patients n = 85 (%) | Hospitalized Patients n = 73 (%) | ||
---|---|---|---|---|
Death/Transition to Hospice Documented n = 32 | Death/Transition to Hospice not Documented n = 41 | Chi-square p-Value | ||
Males | 47 (55.3) | 25 (78.1) | 18 (43.9) | 0.003 |
Age ≤70 Years | 50 (58.5) | 12 (37.5) | 27 (65.8) | 0.016 |
African Americans | 55 (65.5) | 20 (62.5) | 27 (67.5) | 0.462 |
Local household income below the state median | 50 (63.3) | 18 (56.2) | 25 (60.9) | 0.684 |
Charlson Comorbidity Index Quartiles (CCI score range) | n = 76 | n = 31 | n = 37 | 0.081 |
Quartile 1 (1–3) | 25 (32.8) | 7 (22.5) | 13 (35.1) | |
Quartile 2 (4–6) | 23 (30.2) | 14 (45.1) | 7 (18.9) | |
Quartile 3 (7–8) | 15 (19.7) | 7 (22.5) | 8 (21.6) | |
Quartile 4 (9–16) | 13 (17.1) | 3 (9.6) | 9 (24.3) | |
Cancer Type | 0.351 | |||
Metastatic Solid | 31 (36.5) | 12 (37.5) | 14 (34.1) | |
Non-metastatic Solid | 32 (37.6) | 10 (31.2) | 19 (46.3) | |
Hematological | 22 (25.9) | 10 (31.2) | 8 (19.5) | |
COVID-19-related treatment | ||||
Steroids | 51 (60) | 24 (75.0) | 27 (65.8) | 0.398 |
Hydroxychloroquine | 62 (72.9) | 27 (84.4) | 34 (82.9) | 0.868 |
Azithromycin | 21 (24.7) | 8 (25.0) | 11 (26.8) | 0.860 |
Tocilizumab | 3 (3.5) | 2 (6.2) | 1 (2.4) | 0.416 |
Recent Cancer-directed treatment | 47 (55.3) | 17 (53.1) | 20 (48.8) | 0.713 |
Hormonal agents | 11 (12.9) | |||
Non-Hormonal systemic agents: | ||||
Cytotoxic agents | 19 (22.3) | |||
Immunotherapy | 6 (7.1) | |||
Others | 15 (17.6) | |||
Radiation therapy | 6 (7.1) | |||
Surgery | 4 (4.7) | |||
ICU admission | 30 (35.3) | 23 (71.9) | 7 (17.1) | <0.001 |
Coded status updated to DNR/DNI/CC | 39 (45.9) | 30 (93.7) | 9 (21.9) | <0.001 |
Lab Parameters (Mean Values) | All Patients (n = 85) | Hospitalized Patients (n = 73) | ||
---|---|---|---|---|
Overall Mean ± SD, Median [min, max] | Death/Transition to Hospice Documented Mean ± SD (n = 32) | Death/Transition to Hospice Not Documented Mean ± SD (n = 41) | Two-Sample Wilcoxon Rank-Sum (Mann–Whitney) Test p-Value | |
Nadir Values | ||||
Lymphocyte count (k/µL) | 1.1 ± 3.1 | 1.6 ± 4.7 (32) | 0.7 ± 1.2 (41) | 0.906 |
0.5 [0, 24.8] | ||||
ANC (k/µL) | 3.9 ± 3.2 | 5.1 ± 4.1 (32) | 3.1 ± 2.1 (41) | 0.014 |
3.1 [0.2, 20.4] | ||||
Platelet count (k/µL) | 163.8 ± 116.3 | 146.7 ± 96.8 (32) | 178.8 ± 133.4 (41) | 0.256 |
149 [24, 900] | ||||
Peak Values | ||||
Serum Cr (mg/dL) | 1.8 ± 1.9 | 2.4 ± 2.3 (19) | 1.5 ± 1.5 (32) | 0.019 |
1.2 [0.6, 7.9] | ||||
AST (IU/L) | 104.8 ± 154.4 | 147.1 ± 206.9 (30) | 78.4 ± 98.2 (40) | 0.013 |
56 [14, 1031] | ||||
ALT (IU/L) | 66.5 ± 102.6 | 86.1 ± 142.1 (30) | 55.4 ± 61.6 (40) | 0.264 |
31 [6, 775] | ||||
LDH (IU/L) | 513.1 ± 332.2 | 616.7 ± 375.7 (30) | 437.1 ± 277.2 (41) | 0.007 |
405 [112, 1812] | ||||
CPK (IU/L) | 425.3 ± 812.2 | 586.2 ± 1054.1 (29) | 311.6 ± 572.9 (41) | 0.079 |
146 [18, 5270] | ||||
Triglyceride (mg/dL) | 216.3 ± 126.4 | 234.9 ± 145.6 (22) | 190.8 ± 92.5 (16) | 0.604 |
175.5 [47, 602] | ||||
Hs-Troponin (ng/L) | 855.1 ± 3414.9 | 1316.4 ± 4417 (20) | 195.9 ± 542.2 (14) | 0.004 |
101 [19, 20,000] | ||||
BNP (pg/mL) | 230.7 ± 378.5 | 399.3 ± 511.1 (18) | 98.8 ± 131.6 (23) | 0.004 |
75 [9, 1744] | ||||
Ferritin (ng/mL) | 3470.6 ± 10030.3 | 5839.3 ± 14863.3 (31) | 1679.6 ± 2291.7 (41) | 0.084 |
1277.5 [52, 78,689] | ||||
CRP (mg/dL) | 17.4 ± 10.5 | 21.2 ± 11.5 (28) | 14.8 ± 9.0 (41) | 0.019 |
15.3 [0.1, 46.1] | ||||
IL-6 (pg/mL) | 126.4 ± 185.4 | 163.3 ± 209.2 (17) | 36.7 ± 42.2 (7) | 0.092 |
39.5 [5, 582] | ||||
D-Dimer (µg/mL) | 5.5 ± 6.8 | 8.1 ± 9.1 (27) | 3.6 ± 3.7 (39) | 0.011 |
Factor | Odds Ratio for Mortality/Transition to Hospice | p-Value | 95% Confidence Interval |
---|---|---|---|
Age: >70 vs. ≤70 Years | 4.7 | 0.012 | 1.3–15.9 |
Gender: Male vs. Female | 4.8 | 0.008 | 1.5–15.8 |
Race: African American vs. Caucasian | 2.2 | 0.227 | 0.6–8.3 |
Charlson Comorbidity Index score | 0.9 | 0.793 | 0.8–1.1 |
Median household income for zip code of residence ($): ≥54,938 vs. <54,938 | 0.8 | 0.769 | 0.2–2.7 |
Factors | Admitted to ICU n = 30 (%) | Admitted to General Floor n = 43 (%) | Chi-Square p-Value |
---|---|---|---|
Males | 20 (66.7) | 23 (53.5) | 0.260 |
Age ≤70 Years | 16 (53.3) | 23 (53.5) | 0.990 |
African Americans | 21 (72.4) | 26 (63.4) | 0.430 |
Died/Transitioned to Hospice care | 23 (85.2) | 9 (20.9) | <0.001 |
Local Household Income Below the State Median | 17 (56.6) | 26 (60.5) | 0.756 |
Cancer Type | 0.896 | ||
Metastatic Solid | 11 (36.7) | 15 (34.9) | |
Non-metastatic Solid | 11 (36.7) | 18 (41.9) | |
Hematological | 8 (26.6) | 10 (23.2) | |
Received Steroids | 23 (76.7) | 28 (65.1) | 0.290 |
Received Hydroxychloroquine | 28 (93.3) | 33 (76.7) | 0.060 |
Received Azithromycin | 9 (30) | 10 (23.3) | 0.518 |
Received Tocilizumab | 3 (10) | 0 (0) | 0.065 |
Recent Cancer-directed Therapy | 20 (66.7) | 17 (39.5) | 0.023 |
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Share and Cite
Singh, S.R.K.; Thanikachalam, K.; Jabbour-Aida, H.; Poisson, L.M.; Khan, G. COVID-19 and Cancer: Lessons Learnt from a Michigan Hotspot. Cancers 2020, 12, 2377. https://doi.org/10.3390/cancers12092377
Singh SRK, Thanikachalam K, Jabbour-Aida H, Poisson LM, Khan G. COVID-19 and Cancer: Lessons Learnt from a Michigan Hotspot. Cancers. 2020; 12(9):2377. https://doi.org/10.3390/cancers12092377
Chicago/Turabian StyleSingh, Sunny R. K., Kannan Thanikachalam, Hiba Jabbour-Aida, Laila M. Poisson, and Gazala Khan. 2020. "COVID-19 and Cancer: Lessons Learnt from a Michigan Hotspot" Cancers 12, no. 9: 2377. https://doi.org/10.3390/cancers12092377