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Noh S, Bertini C, Mira‐Avendano I, Kaous M, Patel B, Faiz SA, Shannon VR, Balachandran DD, Bashoura L, Adachi R, Evans SE, Dickey B, Wu C, Shroff GS, Manzano J, Granwehr B, Holloway S, Dickson K, Mohammed A, Muthu M, Song H, Chung C, Wu J, Lee L, Jiang Y, Khawaja F, Sheshadri A. Interstitial lung abnormalities after hospitalization for COVID-19 in patients with cancer: A prospective cohort study. Cancer Med 2023; 12:17753-17765. [PMID: 37592894 PMCID: PMC10524033 DOI: 10.1002/cam4.6396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION Survivors of SARS-CoV-2 pneumonia often develop persistent respiratory symptom and interstitial lung abnormalities (ILAs) after infection. Risk factors for ILA development and duration of ILA persistence after SARS-CoV-2 infection are not well described in immunocompromised hosts, such as cancer patients. METHODS We conducted a prospective cohort study of 95 patients at a major cancer center and 45 patients at a tertiary referral center. We collected clinical and radiographic data during the index hospitalization for COVID-19 pneumonia and measured pneumonia severity using a semi-quantitative radiographic score, the Radiologic Severity Index (RSI). Patients were evaluated in post-COVID-19 clinics at 3 and 6 months after discharge and underwent comprehensive pulmonary evaluations (symptom assessment, chest computed tomography, pulmonary function tests, 6-min walk test). The association of clinical and radiological factors with ILAs at 3 and 6 months post-discharge was measured using univariable and multivariable logistic regression. RESULTS Sixty-six (70%) patients of cancer cohort had ILAs at 3 months, of whom 39 had persistent respiratory symptoms. Twenty-four (26%) patients had persistent ILA at 6 months after hospital discharge. In adjusted models, higher peak RSI at admission was associated with ILAs at 3 (OR 1.5 per 5-point increase, 95% CI 1.1-1.9) and 6 months (OR 1.3 per 5-point increase, 95% CI 1.1-1.6) post-discharge. Fibrotic ILAs (reticulation, traction bronchiectasis, and architectural distortion) were more common at 6 months post-discharge. CONCLUSIONS Post-COVID-19 ILAs are common in cancer patients 3 months after hospital discharge, and peak RSI and older age are strong predictors of persistent ILAs.
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Affiliation(s)
- Sungryong Noh
- Division of Critical Care, Pulmonary and Sleep MedicineMcGovern Medical SchoolHoustonTexasUSA
| | - Christopher Bertini
- Department of Internal MedicineMcGovern Medical School at UT HealthHoustonTexasUSA
| | - Isabel Mira‐Avendano
- Division of Critical Care, Pulmonary and Sleep MedicineMcGovern Medical SchoolHoustonTexasUSA
| | - Maryam Kaous
- Division of Critical Care, Pulmonary and Sleep MedicineMcGovern Medical SchoolHoustonTexasUSA
| | - Bela Patel
- Division of Critical Care, Pulmonary and Sleep MedicineMcGovern Medical SchoolHoustonTexasUSA
| | - Saadia A. Faiz
- Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Vickie R. Shannon
- Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Diwakar D. Balachandran
- Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Lara Bashoura
- Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Roberto Adachi
- Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Scott E. Evans
- Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Burton Dickey
- Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Carol Wu
- Department of Thoracic ImagingThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Girish S. Shroff
- Department of Thoracic ImagingThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Joanna‐Grace Manzano
- Department of Hospital MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Bruno Granwehr
- Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Shannon Holloway
- Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Kodwo Dickson
- Department of Hospital MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Alyssa Mohammed
- Department of Hospital MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Mayoora Muthu
- Department of Hospital MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Hui Song
- Data‐Driven Determinants for COVID‐19 Oncology Discovery Effort (D3CODE) TeamThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Caroline Chung
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Jia Wu
- Department of Imaging Physics, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Lyndon Lee
- Department of Internal MedicineMcGovern Medical School at UT HealthHoustonTexasUSA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Fareed Khawaja
- Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ajay Sheshadri
- Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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Fernández-Cruz A, Puyuelo A, Núñez Martín-Buitrago L, Sánchez-Chica E, Díaz-Pedroche C, Ayala R, Lizasoain M, Duarte R, Lumbreras C, Antonio Vargas J. Higher mortality of hospitalized haematologic patients with COVID-19 compared to non-haematologic is driven by thrombotic complications and development of ARDS: An age-matched cohorts study. CLINICAL INFECTION IN PRACTICE 2022; 13:100137. [PMID: 35187467 PMCID: PMC8843327 DOI: 10.1016/j.clinpr.2022.100137] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/18/2022] [Accepted: 02/04/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The characteristics of COVID-19 in haematologic patients compared to non-haematologic patients have seldom been analyzed. Our aim was to analyze whether there are differences in clinical characteristics and outcome of haematologic patients with COVID-19 as compared to non-haematologic. PATIENTS AND METHODS Retrospective cohort study in 2 University hospitals of patients admitted with laboratory-confirmed COVID-19 included in the SEMICOVID19 database. The cohort with underlying haematologic disease was compared to a cohort of age and date-of-COVID-19-matched controls without haematologic disease (1:2). RESULTS 71 cases and 142 controls were included from March-May 2020.Twenty (28.1%) had received recent chemotherapy. Twelve (16.9%) were stem cell transplant recipients (SCT). Eleven (15.5%) were neutropenic concurrently with COVID-19 diagnosis.Haematologic patients presented ARDS (58.5 vs 20.7%, p = 0.0001), thrombotic complications (15.7 vs 2.1%, p = 0.002), DIC (5.7 vs 0.0%, p = 0.011), heart failure (14.3 vs 4.9%, p = 0.029) and required ICU admission (15.5 vs 2.8%, p = 0.001), MV (14.1% vs 2.1%, p 0.001), steroid (64.8 vs 33.1%, p = 0.0001), tocilizumab (33.8 vs 8.5%, p = 0.0001) or anakinra treatment (9.9% vs 0%, p = 0.0001) more often. In-hospital mortality was significantly higher (38.0% vs 18.3%, p = 0.002). CONCLUSIONS Our results suggest COVID-19 has worse outcomes in haematologic patients than in non-haematologic, independently of age, and that the development of ARDS and thrombotic complications drive the higher in-hospital mortality.
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Key Words
- ARDS, acute respiratory distress syndrome
- C-RP, C-reactive protein
- CI, confidence interval
- CLL, chronic lymphocytic leukemia
- COVID-19
- COVID-19, Coronavirus disease 2019
- DIC, disseminated intravascular coagulation
- ECOG scale, Eastern Cooperative Oncology Group scale
- G-CSF, granulocyte stimulating factor
- HFNC, high flow nasal cannula
- Haematologic
- ICU, Intensive Care Unit
- IL6, Interleukin 6
- IQR, interquartile range
- LDH, Lactate dehydrogenase
- MDS, myelodysplastic syndrome
- MM, multiple myeloma
- MV, mechanical ventilation
- Mortality
- NHL, non-Hodgkin lymphoma
- NIMV, non-invasive mechanical ventilation
- OR, Odds ratio
- Outcome
- PEEP, positive end expiratory pressure
- PaO2/FiO2, arterial oxygen tension/inspiratory oxygen fraction
- SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2
- SCT, stem cell transplantation
- SD, standard deviation
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Affiliation(s)
- Ana Fernández-Cruz
- Infectious Diseases Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
- Fundación de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, Spain
| | - Alba Puyuelo
- Haematology Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | | | - Carmen Díaz-Pedroche
- Internal Medicine Department, Hospital Doce de Octubre, Madrid, Spain
- Fundación para la Investigación Biomédica del Hospital Universitario, 12 de Octubre, Spain
- Universidad Complutense de Madrid, Spain
| | - Rosa Ayala
- Haematology Department, Hospital Doce de Octubre, Madrid, Spain
- Fundación para la Investigación Biomédica del Hospital Universitario, 12 de Octubre, Spain
| | - Manuel Lizasoain
- Infectious Diseases Department, Hospital Doce de Octubre, Madrid, Spain
- Fundación para la Investigación Biomédica del Hospital Universitario, 12 de Octubre, Spain
| | - Rafael Duarte
- Haematology Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
- Fundación de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, Spain
- Universidad Autónoma de Madrid, Spain
| | - Carlos Lumbreras
- Infectious Diseases Department, Hospital Doce de Octubre, Madrid, Spain
- Fundación para la Investigación Biomédica del Hospital Universitario, 12 de Octubre, Spain
- Universidad Complutense de Madrid, Spain
| | - Juan Antonio Vargas
- Internal Medicine Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
- Fundación de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, Spain
- Universidad Autónoma de Madrid, Spain
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Sheshadri A, Godoy M, Erasmus JJ, Gruschkus S, Hasan A, Evans SE, Barreda-Garcia J, Chemaly RF, Dickey B, Ost D. Progression of the Radiologic Severity Index is associated with increased mortality and healthcare resource utilisation in acute leukaemia patients with pneumonia. BMJ Open Respir Res 2019; 6:e000471. [PMID: 31921429 PMCID: PMC6937103 DOI: 10.1136/bmjresp-2019-000471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 12/25/2022] Open
Abstract
Background Pneumonia is a major cause of mortality and morbidity, but the development of new antimicrobials is lacking. Radiological assessment of pneumonia severity may serve as an effective intermediate endpoint to reduce barriers to successful completion of antimicrobial trials. We sought to determine whether the Radiologic Severity Index (RSI) correlated with mortality and healthcare resource utilisation in patients with acute leukaemia undergoing induction chemotherapy. Methods We measured RSI (range 0–72) on all chest radiographs performed within 33 days of induction chemotherapy in 165 haematological malignancy patients with pneumonia. Peak RSI was defined as the highest RSI score within 33 days of induction. We used extended Cox proportional hazards models to measure the association of time-varying RSI with all-cause mortality within the first 33 days after induction chemotherapy, and logistic regression or generalised models to measure the association of RSI with total daily cost and healthcare resource utilisation. Results After adjustment for clinical variables, each one-point increase in RSI was associated with a 7% increase in all-cause 33-day mortality (HR 1.07, 95% CI 1.05 to 1.09, p<0.0001). Peak RSI values of 37.5 or higher were associated with 86% higher daily direct costs (p<0.0001), more days in intensive care unit (9.9 vs 4.8 days, p=0.001) and higher odds for mechanical ventilation (OR 12.1, p<0.0001). Conclusions Greater radiological severity as measured by RSI was associated with increased mortality and morbidity in acute leukaemia patients with pneumonia. RSI is a promising intermediate marker of pneumonia severity and is well suited for use in antimicrobial trials.
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Affiliation(s)
- Ajay Sheshadri
- Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Myrna Godoy
- Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeremy J Erasmus
- Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen Gruschkus
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Arain Hasan
- Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Scott E Evans
- Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Javier Barreda-Garcia
- Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roy F Chemaly
- Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Burton Dickey
- Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Ost
- Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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