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García de Herreros M, Laguna JC, Padrosa J, Barreto TD, Chicote M, Font C, Grafiá I, Llavata L, Seguí E, Tuca A, Viladot M, Zamora-Martínez C, Fernández-Méndez S, Téllez A, Nicolás JM, Prat A, Castro-Rebollo P, Marco-Hernández J. Characterisation and Outcomes of Patients with Solid Organ Malignancies Admitted to the Intensive Care Unit: Mortality and Impact on Functional Status and Oncological Treatment. Diagnostics (Basel) 2024; 14:730. [PMID: 38611643 PMCID: PMC11011727 DOI: 10.3390/diagnostics14070730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Despite the increasing number of ICU admissions among patients with solid tumours, there is a lack of tools with which to identify patients who may benefit from critical support. We aim to characterize the clinical profile and outcomes of patients with solid malignancies admitted to the ICU. METHODS Retrospective observational study of patients with cancer non-electively admitted to the ICU of the Hospital Clinic of Barcelona (Spain) between January 2019 and December 2019. Data regarding patient and neoplasm characteristics, ICU admission features and outcomes were collected from medical records. RESULTS 97 ICU admissions of 84 patients were analysed. Lung cancer (22.6%) was the most frequent neoplasm. Most of the patients had metastatic disease (79.5%) and were receiving oncological treatment (75%). The main reason for ICU admission was respiratory failure (38%). Intra-ICU and in-hospital mortality rates were 9.4% and 24%, respectively. Mortality rates at 1, 3 and 6 months were 19.6%, 36.1% and 53.6%. Liver metastasis, gastrointestinal cancer, hypoalbuminemia, elevated basal C-reactive protein, ECOG-PS greater than 2 at ICU admission, admission from ward and an APACHE II score over 14 were related to higher mortality. Functional status was severely affected at discharge, and oncological treatment was definitively discontinued in 40% of the patients. CONCLUSION Medium-term mortality and functional deterioration of patients with solid cancers non-electively admitted to the ICU are high. Surrogate markers of cachexia, liver metastasis and poor ECOG-PS at ICU admission are risk factors for mortality.
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Affiliation(s)
- Marta García de Herreros
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Juan Carlos Laguna
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Joan Padrosa
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Tanny Daniela Barreto
- Radiation Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain;
| | - Manoli Chicote
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
| | - Carme Font
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Ignacio Grafiá
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Lucía Llavata
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
| | - Elia Seguí
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Albert Tuca
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Margarita Viladot
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Carles Zamora-Martínez
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Sara Fernández-Méndez
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Adrián Téllez
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Josep Maria Nicolás
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Aleix Prat
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Pedro Castro-Rebollo
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
| | - Javier Marco-Hernández
- Medical Oncology Department, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (M.G.d.H.); (J.C.L.); (J.P.); (M.C.); (C.F.); (I.G.); (L.L.); (E.S.); (A.T.); (M.V.); (C.Z.-M.); (A.P.)
- Medical Intensive Care Unit, Internal Medicine Department Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain; (S.F.-M.); (A.T.); (J.M.N.); (P.C.-R.)
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Grafia I, Chumbita M, Seguí E, Cardozo C, Laguna JC, García de Herreros M, Garcia-Pouton N, Villaescusa A, Pitart C, Rico-Caballero V, Marco-Hernández J, Zamora C, Viladot M, Padrosa J, Tuca A, Mayor-Vázquez E, Marco F, Martínez JA, Mensa J, Garcia-Vidal C, Soriano A, Puerta-Alcalde P. Epidemiology and risk factors for recurrence in biliary source bloodstream infection episodes in oncological patients. Microbiol Spectr 2023; 11:e0214223. [PMID: 37610217 PMCID: PMC10580831 DOI: 10.1128/spectrum.02142-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023] Open
Abstract
We aimed to describe the characteristics and outcomes of biliary source bloodstream infections (BSIs) in oncological patients. Secondarily, we analyzed risk factors for recurrent BSI episodes. All episodes of biliary source BSIs in oncological patients were prospectively collected (2008-2019) and retrospectively analyzed. Logistic regression analyses were performed. A rule to stratify patients into risk groups for recurrent biliary source BSI was conducted. Four hundred biliary source BSIs were documented in 291 oncological patients. The most frequent causative agents were Escherichia coli (42%) and Klebsiella spp. (27%), and 86 (21.5%) episodes were caused by multidrug-resistant Gram-negative bacilli (MDR-GNB). The rates of MDR-GNB increased over time. Overall, 73 patients developed 118 recurrent BSI episodes. Independent risk factors for recurrent BSI episodes were prior antibiotic therapy (OR 3.781, 95% CI 1.906-7.503), biliary prosthesis (OR 2.232, 95% CI 1.157-4.305), prior admission due to suspected biliary source infection (OR 4.409, 95% CI 2.338-8.311), and BSI episode caused by an MDR-GNB (OR 2.857, 95% CI 1.389-5.874). With these variables, a score was generated that predicted recurrent biliary source BSI with an area under the receiver operating characteristic (ROC) curve of 0.819. Inappropriate empirical antibiotic treatment (IEAT) was administered in 23.8% of patients, and 30-d mortality was 19.5%. As a conclusion, biliary source BSI in oncological patients is mainly caused by GNB, with high and increasing MDR rates, frequent IEAT, and high mortality. Recurrent BSI episodes are frequent. A simple score to identify recurrent episodes was developed to potentially establish prophylactic strategies. IMPORTANCE This study shows that biliary source bloodstream infections (BSIs) in oncological patients are mainly caused by Gram-negative bacilli (GNB), with high and increasing rates of multidrug resistance. Importantly, recurrent biliary source BSI episodes were very frequent and associated with delays in chemotherapy, high rates of inappropriate empirical antibiotic therapy, and high 30-d mortality (19.5%). Using the variable independently associated with recurrent BSI episodes, a score was generated that predicted recurrent biliary source BSI with high accuracy. This score could be used to establish prophylactic strategies and lower the risk of relapsing episodes and the associated morbidity and mortality.
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Affiliation(s)
- Ignacio Grafia
- Medical Oncology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Mariana Chumbita
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Elia Seguí
- Medical Oncology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Celia Cardozo
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | | | | | | | - Ana Villaescusa
- Medical Oncology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Cristina Pitart
- Microbiology Department, Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain
| | | | - Javier Marco-Hernández
- Internal Medicine Department, Supportive and Palliative Care in Cancer Unit, Hospital Clínic, Barcelona, Spain
| | - Carles Zamora
- Medical Oncology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Margarita Viladot
- Medical Oncology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Joan Padrosa
- Medical Oncology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Albert Tuca
- Medical Oncology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Eric Mayor-Vázquez
- Medical Intensive Care Unit, Internal Medicine Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Francesc Marco
- Microbiology Department, Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Jose A. Martínez
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Josep Mensa
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- CIBERINF, CIBER in Infectious Diseases, Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- CIBERINF, CIBER in Infectious Diseases, Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
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3
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Cortellini A, Tabernero J, Mukherjee U, Salazar R, Sureda A, Maluquer C, Ferrante D, Bower M, Sharkey R, Mirallas O, Plaja A, Cucurull M, Mesia R, Dalla Pria A, Newsom-Davis T, Van Hemelrijck M, Sita-Lumsden A, Apthorp E, Vincenzi B, Di Fazio GR, Tonini G, Pantano F, Bertuzzi A, Rossi S, Brunet J, Lambertini M, Pedrazzoli P, Biello F, D'Avanzo F, Lee AJX, Shawe-Taylor M, Rogers L, Murphy C, Cooper L, Andaleeb R, Khalique S, Bawany S, Ahmed S, Carmona-García MC, Fort-Culillas R, Liñan R, Zoratto F, Rizzo G, Perachino M, Doonga K, Gaidano G, Bruna R, Patriarca A, Martinez-Vila C, Pérez Criado I, Giusti R, Mazzoni F, Antonuzzo L, Santoro A, Parisi A, Queirolo P, Aujayeb A, Rimassa L, Diamantis N, Bertulli R, Fulgenzi CAM, D'Alessio A, Ruiz-Camps I, Saoudi-Gonzalez N, Garcia Illescas D, Medina I, Fox L, Gennari A, Aguilar-Company J, Pinato DJ, Swallow J, Hanbury G, Chung C, Patel M, Dettorre G, Belessiotis K, Saorise D, Jones E, Apthorp E, Moss C, Russell B, Townsend S, Jackson A, Loizidou A, Piccart M, Pommeret F, Colomba-Blameble E, Prat A, Cruz CA, Reyes R, Segui E, Marco-Hernández J, Viladot M, Harbeck N, Wuerstlein R, Henze F, Mahner S, Felip E, Scotti L, Marrari A, Grosso F, Fusco V, Delfanti S, Rossi M, Zambelli A, Tondini C, Chiudinelli L, Franchi M, Libertini M, Provenzano S, Generali D, Grisanti S, Baggi A, Tovazzi V, Ficorella C, Porzio G, Saponara M, Filetti M, Tucci M, Berardi R, Cantini L, Paoloni F, Guida A, Bracarda S, Iglesias M, Sanchez de Torre A, Tagliamento M. SARS-CoV-2 omicron (B.1.1.529)-related COVID-19 sequelae in vaccinated and unvaccinated patients with cancer: results from the OnCovid registry. Lancet Oncol 2023; 24:335-346. [PMID: 36898391 PMCID: PMC9991062 DOI: 10.1016/s1470-2045(23)00056-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND COVID-19 sequelae can affect about 15% of patients with cancer who survive the acute phase of SARS-CoV-2 infection and can substantially impair their survival and continuity of oncological care. We aimed to investigate whether previous immunisation affects long-term sequelae in the context of evolving variants of concern of SARS-CoV-2. METHODS OnCovid is an active registry that includes patients aged 18 years or older from 37 institutions across Belgium, France, Germany, Italy, Spain, and the UK with a laboratory-confirmed diagnosis of COVID-19 and a history of solid or haematological malignancy, either active or in remission, followed up from COVID-19 diagnosis until death. We evaluated the prevalence of COVID-19 sequelae in patients who survived COVID-19 and underwent a formal clinical reassessment, categorising infection according to the date of diagnosis as the omicron (B.1.1.529) phase from Dec 15, 2021, to Jan 31, 2022; the alpha (B.1.1.7)-delta (B.1.617.2) phase from Dec 1, 2020, to Dec 14, 2021; and the pre-vaccination phase from Feb 27 to Nov 30, 2020. The prevalence of overall COVID-19 sequelae was compared according to SARS-CoV-2 immunisation status and in relation to post-COVID-19 survival and resumption of systemic anticancer therapy. This study is registered with ClinicalTrials.gov, NCT04393974. FINDINGS At the follow-up update on June 20, 2022, 1909 eligible patients, evaluated after a median of 39 days (IQR 24-68) from COVID-19 diagnosis, were included (964 [50·7%] of 1902 patients with sex data were female and 938 [49·3%] were male). Overall, 317 (16·6%; 95% CI 14·8-18·5) of 1909 patients had at least one sequela from COVID-19 at the first oncological reassessment. The prevalence of COVID-19 sequelae was highest in the pre-vaccination phase (191 [19·1%; 95% CI 16·4-22·0] of 1000 patients). The prevalence was similar in the alpha-delta phase (110 [16·8%; 13·8-20·3] of 653 patients, p=0·24), but significantly lower in the omicron phase (16 [6·2%; 3·5-10·2] of 256 patients, p<0·0001). In the alpha-delta phase, 84 (18·3%; 95% CI 14·6-22·7) of 458 unvaccinated patients and three (9·4%; 1·9-27·3) of 32 unvaccinated patients in the omicron phase had sequelae. Patients who received a booster and those who received two vaccine doses had a significantly lower prevalence of overall COVID-19 sequelae than unvaccinated or partially vaccinated patients (ten [7·4%; 95% CI 3·5-13·5] of 136 boosted patients, 18 [9·8%; 5·8-15·5] of 183 patients who had two vaccine doses vs 277 [18·5%; 16·5-20·9] of 1489 unvaccinated patients, p=0·0001), respiratory sequelae (six [4·4%; 1·6-9·6], 11 [6·0%; 3·0-10·7] vs 148 [9·9%; 8·4-11·6], p=0·030), and prolonged fatigue (three [2·2%; 0·1-6·4], ten [5·4%; 2·6-10·0] vs 115 [7·7%; 6·3-9·3], p=0·037). INTERPRETATION Unvaccinated patients with cancer remain highly vulnerable to COVID-19 sequelae irrespective of viral strain. This study confirms the role of previous SARS-CoV-2 immunisation as an effective measure to protect patients from COVID-19 sequelae, disruption of therapy, and ensuing mortality. FUNDING UK National Institute for Health and Care Research Imperial Biomedical Research Centre and the Cancer Treatment and Research Trust.
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Affiliation(s)
- Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, London, UK; Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy.
| | - Josep Tabernero
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, UK
| | - Ramon Salazar
- Catalan Institute of Oncology (ICO), University of Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), CIBERONC, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Sureda
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Clara Maluquer
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Daniela Ferrante
- Unit of Medical Statistics, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Rachel Sharkey
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Oriol Mirallas
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - Andrea Plaja
- Medical Oncology Department, B-ARGO Group, IGTP, Catalan Institute of Oncology, Badalona, Spain
| | - Marc Cucurull
- Medical Oncology Department, B-ARGO Group, IGTP, Catalan Institute of Oncology, Badalona, Spain
| | - Ricard Mesia
- Medical Oncology Department, B-ARGO Group, IGTP, Catalan Institute of Oncology, Badalona, Spain
| | - Alessia Dalla Pria
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Thomas Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Mieke Van Hemelrijck
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK; Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | | | | | - Bruno Vincenzi
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Giuseppina Rita Di Fazio
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Giuseppe Tonini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Francesco Pantano
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Alexia Bertuzzi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Sabrina Rossi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Matteo Lambertini
- Medical Oncology Department, UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy
| | - Paolo Pedrazzoli
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy; Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Biello
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Ospedale Maggiore della Caritá, Novara, Italy
| | - Francesca D'Avanzo
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Ospedale Maggiore della Caritá, Novara, Italy
| | - Alvin J X Lee
- Cancer Division, University College London Hospitals, London, UK
| | | | - Lucy Rogers
- Cancer Division, University College London Hospitals, London, UK
| | - Cian Murphy
- Cancer Division, University College London Hospitals, London, UK
| | - Lee Cooper
- Cancer Division, University College London Hospitals, London, UK
| | - Ramis Andaleeb
- Cancer Division, University College London Hospitals, London, UK
| | - Saira Khalique
- Cancer Division, University College London Hospitals, London, UK
| | - Samira Bawany
- Cancer Division, University College London Hospitals, London, UK
| | - Sarah Ahmed
- Cancer Division, University College London Hospitals, London, UK
| | - M Carmen Carmona-García
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Roser Fort-Culillas
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Raquel Liñan
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | | | - Gianpiero Rizzo
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Perachino
- Medical Oncology Department, UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy
| | - Kris Doonga
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Ospedale Maggiore della Caritá, Novara, Italy
| | - Riccardo Bruna
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Ospedale Maggiore della Caritá, Novara, Italy
| | - Andrea Patriarca
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Ospedale Maggiore della Caritá, Novara, Italy
| | | | | | | | | | | | - Armando Santoro
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessandro Parisi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paola Queirolo
- Melanoma and Sarcoma Medical Treatment Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Rossella Bertulli
- Medical Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia A M Fulgenzi
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Antonio D'Alessio
- Department of Surgery and Cancer, Imperial College London, London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Isabel Ruiz-Camps
- Department of Infectious Diseases, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Nadia Saoudi-Gonzalez
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - David Garcia Illescas
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - Irene Medina
- Department of Hematology, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Laura Fox
- Department of Hematology, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Ospedale Maggiore della Caritá, Novara, Italy
| | - Juan Aguilar-Company
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, IOB-Quiron, UVic-UCC, Barcelona, Spain; Department of Infectious Diseases, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
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Pinato DJ, Aguilar-Company J, Ferrante D, Hanbury G, Bower M, Salazar R, Mirallas O, Sureda A, Plaja A, Cucurull M, Mesia R, Townsend S, Jackson A, Dalla Pria A, Newsom-Davis T, Handford J, Sita-Lumsden A, Apthorp E, Vincenzi B, Bertuzzi A, Brunet J, Lambertini M, Maluquer C, Pedrazzoli P, Biello F, Sinclair A, Bawany S, Khalique S, Rossi S, Rogers L, Murphy C, Belessiotis K, Carmona-García MC, Sharkey R, García-Illescas D, Rizzo G, Perachino M, Saoudi-Gonzalez N, Doonga K, Fox L, Roldán E, Gaidano G, Ruiz-Camps I, Bruna R, Patriarca A, Martinez-Vila C, Cantini L, Zambelli A, Giusti R, Mazzoni F, Caliman E, Santoro A, Grosso F, Parisi A, Queirolo P, Aujayeb A, Rimassa L, Prat A, Tucci M, Libertini M, Grisanti S, Mukherjee U, Diamantis N, Fusco V, Generali D, Provenzano S, Gennari A, Tabernero J, Cortellini A, Evans JS, Swallow J, Chung C, Patel M, Dettorre G, Ottaviani D, Chowdhury A, Merry E, Chopra N, Lee AJX, Sng CCT, Yu T, Shawe-Taylor M, Bain HDC, Wong YNS, Galazi M, Benafif S, Dileo P, Earnshaw I, Patel G, Wu A, Soosaipillai G, Cooper L, Andaleeb R, Dolly S, Apthorp E, Srikandarajah K, Jones E, Van Hemelrijck M, Moss C, Russell B, Chester J, Loizidou A, Piccart M, Cruz CA, Reyes R, Segui E, Marco-Hernández J, Viladot M, Eremiev S, Fort-Culillas R, Garcia I, Liñan R, Roqué Lloveras A, Harbeck N, Wuerstlein R, Henze F, Mahner S, Felip E, Pous A, D'Avanzo F, Scotti L, Krengli M, Marrari A, Delfanti S, Maconi A, Betti M, Tonini G, Di Fazio GR, Tondini C, Chiudinelli L, Franchi M, Libertini M, Bertulli R, Baggi A, Tovazzi V, Ficorella C, Porzio G, Saponara M, Filetti M, Zoratto F, Paoloni F, Berardi R, Guida A, Bracarda S, Iglesias M, Sanchez de Torre A, Tagliamento M, Colomba E, Pommeret F. Outcomes of the SARS-CoV-2 omicron (B.1.1.529) variant outbreak among vaccinated and unvaccinated patients with cancer in Europe: results from the retrospective, multicentre, OnCovid registry study. Lancet Oncol 2022; 23:865-875. [PMID: 35660139 PMCID: PMC9162476 DOI: 10.1016/s1470-2045(22)00273-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The omicron (B.1.1.529) variant of SARS-CoV-2 is highly transmissible and escapes vaccine-induced immunity. We aimed to describe outcomes due to COVID-19 during the omicron outbreak compared with the prevaccination period and alpha (B.1.1.7) and delta (B.1.617.2) waves in patients with cancer in Europe. METHODS In this retrospective analysis of the multicentre OnCovid Registry study, we recruited patients aged 18 years or older with laboratory-confirmed diagnosis of SARS-CoV-2, who had a history of solid or haematological malignancy that was either active or in remission. Patient were recruited from 37 oncology centres from UK, Italy, Spain, France, Belgium, and Germany. Participants were followed up from COVID-19 diagnosis until death or loss to follow-up, while being treated as per standard of care. For this analysis, we excluded data from centres that did not actively enter new data after March 1, 2021 (in France, Germany, and Belgium). We compared measures of COVID-19 morbidity, which were complications from COVID-19, hospitalisation due to COVID-19, and requirement of supplemental oxygen and COVID-19-specific therapies, and COVID-19 mortality across three time periods designated as the prevaccination (Feb 27 to Nov 30, 2020), alpha-delta (Dec 1, 2020, to Dec 14, 2021), and omicron (Dec 15, 2021, to Jan 31, 2022) phases. We assessed all-cause case-fatality rates at 14 days and 28 days after diagnosis of COVID-19 overall and in unvaccinated and fully vaccinated patients and in those who received a booster dose, after adjusting for country of origin, sex, age, comorbidities, tumour type, stage, and status, and receipt of systemic anti-cancer therapy. This study is registered with ClinicalTrials.gov, NCT04393974, and is ongoing. FINDINGS As of Feb 4, 2022 (database lock), the registry included 3820 patients who had been diagnosed with COVID-19 between Feb 27, 2020, and Jan 31, 2022. 3473 patients were eligible for inclusion (1640 [47·4%] were women and 1822 [52·6%] were men, with a median age of 68 years [IQR 57-77]). 2033 (58·5%) of 3473 were diagnosed during the prevaccination phase, 1075 (31·0%) during the alpha-delta phase, and 365 (10·5%) during the omicron phase. Among patients diagnosed during the omicron phase, 113 (33·3%) of 339 were fully vaccinated and 165 (48·7%) were boosted, whereas among those diagnosed during the alpha-delta phase, 152 (16·6%) of 915 were fully vaccinated and 21 (2·3%) were boosted. Compared with patients diagnosed during the prevaccination period, those who were diagnosed during the omicron phase had lower case-fatality rates at 14 days (adjusted odds ratio [OR] 0·32 [95% CI 0·19-0·61) and 28 days (0·34 [0·16-0·79]), complications due to COVID-19 (0·26 [0·17-0·46]), and hospitalisation due to COVID-19 (0·17 [0·09-0·32]), and had less requirements for COVID-19-specific therapy (0·22 [0·15-0·34]) and oxygen therapy (0·24 [0·14-0·43]) than did those diagnosed during the alpha-delta phase. Unvaccinated patients diagnosed during the omicron phase had similar crude case-fatality rates at 14 days (ten [25%] of 40 patients vs 114 [17%] of 656) and at 28 days (11 [27%] of 40 vs 184 [28%] of 656) and similar rates of hospitalisation due to COVID-19 (18 [43%] of 42 vs 266 [41%] of 652) and complications from COVID-19 (13 [31%] of 42 vs 237 [36%] of 659) as those diagnosed during the alpha-delta phase. INTERPRETATION Despite time-dependent improvements in outcomes reported in the omicron phase compared with the earlier phases of the pandemic, patients with cancer remain highly susceptible to SARS-CoV-2 if they are not vaccinated against SARS-CoV-2. Our findings support universal vaccination of patients with cancer as a protective measure against morbidity and mortality from COVID-19. FUNDING National Institute for Health and Care Research Imperial Biomedical Research Centre and the Cancer Treatment and Research Trust.
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Cortellini A, Gennari A, Pommeret F, Patel G, Newsom-Davis T, Bertuzzi A, Viladot M, Aguilar-Company J, Mirallas O, Felip E, Lee AJX, Pria AD, Sharkey R, Brunet J, Garcia MCC, Chester J, Mukherjee U, Scotti L, Dolly S, Sita-Lumsden A, Ferrante D, Van Hemelrijck M, Moss C, Russell B, Seguí E, Biello F, Krengli M, Marco-Hernández J, Gaidano G, Patriarca A, Bruna R, Roldán E, Fox L, Pous A, Griscelli F, Salazar R, Martinez-Vila C, Sureda A, Loizidou A, Maluquer C, Stoclin A, Iglesias M, Pedrazzoli P, Rizzo G, Santoro A, Rimassa L, Rossi S, Harbeck N, de Torre AS, Vincenzi B, Libertini M, Provenzano S, Generali D, Grisanti S, Berardi R, Tucci M, Mazzoni F, Lambertini M, Tagliamento M, Parisi A, Zoratto F, Queirolo P, Giusti R, Guida A, Zambelli A, Tondini C, Maconi A, Betti M, Colomba E, Diamantis N, Sinclair A, Bower M, Ruiz-Camps I, Pinato DJ. COVID-19 Sequelae and the Host Pro-Inflammatory Response: An Analysis From the OnCovid Registry. J Natl Cancer Inst 2022; 114:979-987. [PMID: 35417006 PMCID: PMC9047221 DOI: 10.1093/jnci/djac057] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/15/2022] [Accepted: 03/11/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND 15% of patients with cancer experience symptomatic sequelae, which impair post COVID-19 outcomes. In this study we investigated whether a pro-inflammatory status is associated with the development of COVID-19 sequelae. METHODS OnCovid recruited 2795 consecutive patients, diagnosed with SARS-CoV-2 infection between 27/02/2020-14/02/2021. This analysis focused on COVID-19 survivors who underwent a clinical re-assessment after the exclusion of patients with haematological malignancies. We evaluated the association of inflammatory markers collected at COVID-19 diagnosis with sequelae, considering the impact of prior systemic anticancer therapy (SACT). RESULTS Out of 1339 patients eligible, 203 experienced at least one sequela (15.2%). Median baseline C-reactive protein (CRP, 77.5 mg/L vs 22.2 mg/L, p<.001), lactate dehydrogenase (LDH, 310 UI/L vs 274 UI/L, p=.028) and neutrophil-to-lymphocyte ratio (NLR, 6.0 vs 4.3, p=.001) were statistically significantly higher among patients who experienced sequelae, while no association were reported for platelet-to-lymphocyte ratio (PLR) and the OnCovid Inflammatory Score (OIS), which includes albumin and lymphocytes. The widest Area under the ROC curve was reported for baseline CRP (AUC 0.66,95%CI:0.63-0.69), followed by the NLR (AUC0.58,95%CI:0.55-0.61) and LDH (AUC=0.57,95%CI:0.52-0.61). Using a fixed categorical multivariable analysis high CRP (OR 2.56,95%CI:1.67-3.91) and NLR (OR 1.45,95%CI:1.01-2.10) were confirmed to be statistically significantly associated with an increased risk of sequelae. Exposure to chemotherapy was associated with a decreased risk of sequelae (OR 0.57,95%CI:0.36-0.91), while no associations with immune checkpoint inhibitors, endocrine therapy, and other types of SACT were found. CONCLUSIONS Although the association between inflammatory status, recent chemotherapy and sequelae warrants further investigations, our findings suggest that a deranged pro-inflammatory reaction at COVID-19 diagnosis may predict for sequelae development.
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Affiliation(s)
- Alessio Cortellini
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Fanny Pommeret
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France
| | - Grisma Patel
- Cancer Division, University College London Hospitals, London, UK
| | - Thomas Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Alexia Bertuzzi
- Medical Oncology and Hematology Unit,Humanitas Cancer Center,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Juan Aguilar-Company
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain.,Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Orial Mirallas
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Eudald Felip
- Medical Oncology Department, B-ARGO Group, IGTP, Catalan Institute of Oncology-Badalona, Spain
| | - Alvin J X Lee
- Cancer Division, University College London Hospitals, London, UK
| | - Alessia Dalla Pria
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Rachel Sharkey
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology,University Hospital Josep Trueta, Girona, Spain
| | - MCarmen Carmona Garcia
- Department of Medical Oncology, Catalan Institute of Oncology,University Hospital Josep Trueta, Girona, Spain
| | - John Chester
- Medical Oncology, School of Medicine, Cardiff University, Cardiff, UK.,Medical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, UK
| | - Lorenza Scotti
- Department of Translational Medicine, Unit of Medical Statistics, University of Piemonte Orientale, Novara, Italy
| | - Saoirse Dolly
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Daniela Ferrante
- Department of Translational Medicine, Unit of Medical Statistics, University of Piemonte Orientale, Novara, Italy
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Charlotte Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Elia Seguí
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Federica Biello
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Marco Krengli
- Division of Radiotherapy, Department of Translational Medicine, University of Piemonte Orientale and Azienda Ospedaliera Maggiore Della Carita, Novara, Italy
| | | | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Andrea Patriarca
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Riccardo Bruna
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Elisa Roldán
- Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Fox
- Hematology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d´Hebron Hospital Universitari, Barcelona, Spain
| | - Anna Pous
- Medical Oncology Department, B-ARGO Group, IGTP, Catalan Institute of Oncology-Badalona, Spain
| | - Franck Griscelli
- Département de Biologie et Pathologie, Gustave Roussy Cancer Campus, Villejuif 94800, France.,Université de Paris, Sorbonne Paris Cité, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
| | - Ramon Salazar
- Department of Medical Oncology, ICO L'Hospitalet, Oncobell Program (IDIBELL),CIBERONC, Hospitalet de Llobregat, Spain
| | | | - Anna Sureda
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Angela Loizidou
- Department of Infectious Diseases, Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Clara Maluquer
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Annabelle Stoclin
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France
| | | | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia Italy
| | - Gianpiero Rizzo
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Armando Santoro
- Medical Oncology and Hematology Unit,Humanitas Cancer Center,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit,Humanitas Cancer Center,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy
| | - Sabrina Rossi
- Medical Oncology and Hematology Unit,Humanitas Cancer Center,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Nadia Harbeck
- Department of Gynecology and Obstetrics, Breast Center and Gynecological Cancer Center and CCC Munich, University Hospital Munich, Munich, Germany
| | | | - Bruno Vincenzi
- Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Michela Libertini
- Medical Oncology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Salvatore Provenzano
- Medical Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Generali
- Multidisciplinary Breast Pathology and Translational Research Unit,ASST Cremona, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
| | | | - Rossana Berardi
- Medical Oncology, AOU Ospedali Riuniti, Polytechnic University of the Marche Region, Ancona, Italy
| | - Marco Tucci
- Section of Medical Oncology, Department of Biomedical Sciences and Clinical Oncology (DIMO), University of Bari 'Aldo Moro', Bari, Italy.,IRCCS, Istituto Tumori Giovanni Paolo II, Bari
| | | | - Matteo Lambertini
- Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Marco Tagliamento
- Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Alessandro Parisi
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Paola Queirolo
- Melanoma and Sarcoma Medical Treatment Unit, IEO - Istituto Europeo di Oncologia, Milan, Italy
| | | | - Annalisa Guida
- Department of Oncology, Azienda Ospedaliera Santa Maria, Terni, Italy
| | | | - Carlo Tondini
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Antonio Maconi
- Infrastruttura Ricerca Formazione Innovazione, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marta Betti
- Infrastruttura Ricerca Formazione Innovazione, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Emeline Colomba
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France
| | - Nikolaos Diamantis
- Department of Translational Medicine, Unit of Medical Statistics, University of Piemonte Orientale, Novara, Italy
| | | | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Isabel Ruiz-Camps
- Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - David J Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK.,Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
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Corbera-Bellalta M, Alba-Rovira R, Muralidharan S, Espígol-Frigolé G, Ríos-Garcés R, Marco-Hernández J, Denuc A, Kamberovic F, Pérez-Galán P, Joseph A, D'Andrea A, Bondensgaard K, Cid MC, Paolini JF. Blocking GM-CSF receptor α with mavrilimumab reduces infiltrating cells, pro-inflammatory markers and neoangiogenesis in ex vivo cultured arteries from patients with giant cell arteritis. Ann Rheum Dis 2022; 81:524-536. [PMID: 35045965 PMCID: PMC8921590 DOI: 10.1136/annrheumdis-2021-220873] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/08/2021] [Indexed: 12/26/2022]
Abstract
Background Effective and safe therapies are needed for the treatment of patients with giant cell arteritis (GCA). Emerging as a key cytokine in inflammation, granulocyte-macrophage colony stimulating factor (GM-CSF) may play a role in promoting inflammation in GCA. Objectives To investigate expression of GM-CSF and its receptor in arterial lesions from patients with GCA. To analyse activation of GM-CSF receptor-associated signalling pathways and expression of target genes. To evaluate the effects of blocking GM-CSF receptor α with mavrilimumab in ex vivo cultured arteries from patients with GCA. Methods Quantitative real time PCR, in situ RNA hybridisation, immunohistochemistry, immunofluorescence and confocal microscopy, immunoassay, western blot and ex vivo temporal artery culture. Results GM-CSF and GM-CSF receptor α mRNA and protein were increased in GCA lesions; enhanced JAK2/STAT5A expression/phosphorylation as well as increased expression of target genes CD83 and Spi1/PU.1 were observed. Treatment of ex vivo cultured GCA arteries with mavrilimumab resulted in decreased transcripts of CD3ε, CD20, CD14 and CD16 cell markers, and reduction of infiltrating CD16 and CD3ε cells was observed by immunofluorescence. Mavrilimumab reduced expression of molecules relevant to T cell activation (human leukocyte antigen-DR [HLA-DR]) and Th1 differentiation (interferon-γ), the pro-inflammatory cytokines: interleukin 6 (IL-6), tumour necrosis factor α (TNFα) and IL-1β, as well as molecules related to vascular injury (matrix metalloprotease 9, lipid peroxidation products and inducible nitric oxide synthase [iNOS]). Mavrilimumab reduced CD34 + cells and neoangiogenesis in GCA lesions. Conclusion The inhibitory effects of mavrilimumab on multiple steps in the GCA pathogenesis cascade in vitro are consistent with the clinical observation of reduced GCA flares in a phase 2 trial and support its development as a therapeutic option for patients with GCA.
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Affiliation(s)
- Marc Corbera-Bellalta
- Vasculitis Research Group, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Roser Alba-Rovira
- Vasculitis Research Group, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Georgina Espígol-Frigolé
- Vasculitis Research Group, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Roberto Ríos-Garcés
- Vasculitis Research Group, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Javier Marco-Hernández
- Vasculitis Research Group, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Farah Kamberovic
- Vasculitis Research Group, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | | | | | - Maria C Cid
- Vasculitis Research Group, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - John F Paolini
- Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, USA
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Pinato DJ, Tabernero J, Bower M, Scotti L, Patel M, Colomba E, Dolly S, Loizidou A, Chester J, Mukherjee U, Zambelli A, Dalla Pria A, Aguilar-Company J, Ottaviani D, Chowdhury A, Merry E, Salazar R, Bertuzzi A, Brunet J, Lambertini M, Tagliamento M, Pous A, Sita-Lumsden A, Srikandarajah K, Colomba J, Pommeret F, Seguí E, Generali D, Grisanti S, Pedrazzoli P, Rizzo G, Libertini M, Moss C, Evans JS, Russell B, Harbeck N, Vincenzi B, Biello F, Bertulli R, Liñan R, Rossi S, Carmona-García MC, Tondini C, Fox L, Baggi A, Fotia V, Parisi A, Porzio G, Saponara M, Cruz CA, García-Illescas D, Felip E, Roqué Lloveras A, Sharkey R, Roldán E, Reyes R, Earnshaw I, Ferrante D, Marco-Hernández J, Ruiz-Camps I, Gaidano G, Patriarca A, Bruna R, Sureda A, Martinez-Vila C, Sanchez de Torre A, Cantini L, Filetti M, Rimassa L, Chiudinelli L, Franchi M, Krengli M, Santoro A, Prat A, Van Hemelrijck M, Diamantis N, Newsom-Davis T, Gennari A, Cortellini A. Prevalence and impact of COVID-19 sequelae on treatment and survival of patients with cancer who recovered from SARS-CoV-2 infection: evidence from the OnCovid retrospective, multicentre registry study. Lancet Oncol 2021; 22:1669-1680. [PMID: 34741822 PMCID: PMC8565932 DOI: 10.1016/s1470-2045(21)00573-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The medium-term and long-term impact of COVID-19 in patients with cancer is not yet known. In this study, we aimed to describe the prevalence of COVID-19 sequelae and their impact on the survival of patients with cancer. We also aimed to describe patterns of resumption and modifications of systemic anti-cancer therapy following recovery from SARS-CoV-2 infection. METHODS OnCovid is an active European registry study enrolling consecutive patients aged 18 years or older with a history of solid or haematological malignancy and who had a diagnosis of RT-PCR confirmed SARS-CoV-2 infection. For this retrospective study, patients were enrolled from 35 institutions across Belgium, France, Germany, Italy, Spain, and the UK. Patients who were diagnosed with SARS-CoV-2 infection between Feb 27, 2020, and Feb 14, 2021, and entered into the registry at the point of data lock (March 1, 2021), were eligible for analysis. The present analysis was focused on COVID-19 survivors who underwent clinical reassessment at each participating institution. We documented prevalence of COVID-19 sequelae and described factors associated with their development and their association with post-COVID-19 survival, which was defined as the interval from post-COVID-19 reassessment to the patients' death or last follow-up. We also evaluated resumption of systemic anti-cancer therapy in patients treated within 4 weeks of COVID-19 diagnosis. The OnCovid study is registered in ClinicalTrials.gov, NCT04393974. FINDINGS 2795 patients diagnosed with SARS-CoV-2 infection between Feb 27, 2020, and Feb 14, 2021, were entered into the study by the time of the data lock on March 1, 2021. After the exclusion of ineligible patients, the final study population consisted of 2634 patients. 1557 COVID-19 survivors underwent a formal clinical reassessment after a median of 22·1 months (IQR 8·4-57·8) from cancer diagnosis and 44 days (28-329) from COVID-19 diagnosis. 234 (15·0%) patients reported COVID-19 sequelae, including respiratory symptoms (116 [49·6%]) and residual fatigue (96 [41·0%]). Sequelae were more common in men (vs women; p=0·041), patients aged 65 years or older (vs other age groups; p=0·048), patients with two or more comorbidities (vs one or none; p=0·0006), and patients with a history of smoking (vs no smoking history; p=0·0004). Sequelae were associated with hospitalisation for COVID-19 (p<0·0001), complicated COVID-19 (p<0·0001), and COVID-19 therapy (p=0·0002). With a median post-COVID-19 follow-up of 128 days (95% CI 113-148), COVID-19 sequelae were associated with an increased risk of death (hazard ratio [HR] 1·80 [95% CI 1·18-2·75]) after adjusting for time to post-COVID-19 reassessment, sex, age, comorbidity burden, tumour characteristics, anticancer therapy, and COVID-19 severity. Among 466 patients on systemic anti-cancer therapy, 70 (15·0%) permanently discontinued therapy, and 178 (38·2%) resumed treatment with a dose or regimen adjustment. Permanent treatment discontinuations were independently associated with an increased risk of death (HR 3·53 [95% CI 1·45-8·59]), but dose or regimen adjustments were not (0·84 [0·35-2·02]). INTERPRETATION Sequelae post-COVID-19 affect up to 15% of patients with cancer and adversely affect survival and oncological outcomes after recovery. Adjustments to systemic anti-cancer therapy can be safely pursued in treatment-eligible patients. FUNDING National Institute for Health Research Imperial Biomedical Research Centre and the Cancer Treatment and Research Trust.
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Affiliation(s)
- David J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
| | - Josep Tabernero
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Mark Bower
- Department of Oncology, Chelsea and Westminster Hospital, London, UK; National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Lorenza Scotti
- Unit of Medical Statistics, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Meera Patel
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Emeline Colomba
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - Saoirse Dolly
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Angela Loizidou
- Department of Infectious Diseases, Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - John Chester
- Medical Oncology, School of Medicine, Cardiff University, Cardiff, UK; Medical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, UK
| | - Alberto Zambelli
- Oncology Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Alessia Dalla Pria
- Department of Oncology, Chelsea and Westminster Hospital, London, UK; National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Juan Aguilar-Company
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Diego Ottaviani
- Cancer Division, University College London Hospitals, London, UK
| | - Amani Chowdhury
- Cancer Division, University College London Hospitals, London, UK
| | - Eve Merry
- Cancer Division, University College London Hospitals, London, UK
| | - Ramon Salazar
- Department of Medical Oncology, ICO L'Hospitalet, Oncobell Program, Hospitalet de Llobregat, Barcelona, Spain
| | - Alexia Bertuzzi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Matteo Lambertini
- Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy
| | - Marco Tagliamento
- Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy
| | - Anna Pous
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | | | | | - Johann Colomba
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - Fanny Pommeret
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - Elia Seguí
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Daniele Generali
- Multidisciplinary Breast Pathology and Translational Research Unit, Azienda Socio Sanitaria Territoriale Cremona, Cremona, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Salvatore Grisanti
- Medical Oncology Unit, Spedali Civili, Brescia, Italy; Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Pedrazzoli
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Gianpiero Rizzo
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Michela Libertini
- Medical Oncology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Charlotte Moss
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Joanne S Evans
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Beth Russell
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Nadia Harbeck
- Department of Gynecology and Obstetrics, Breast Center and Gynecological Cancer Center and Comprehensive Cancer Center Munich, University Hospital Munich, Munich, Germany
| | - Bruno Vincenzi
- Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Federica Biello
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Azienda Ospedaliera Maggiore Della Caritá, Novara, Italy
| | - Rossella Bertulli
- Medical Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Raquel Liñan
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Sabrina Rossi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Maria Carmen Carmona-García
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Carlo Tondini
- Oncology Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Fox
- Haematology, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Alice Baggi
- Medical Oncology Unit, Spedali Civili, Brescia, Italy; Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittoria Fotia
- Oncology Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandro Parisi
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giampero Porzio
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maristella Saponara
- Melanoma and Sarcoma Medical Treatment Unit, Istituto Europeo di Oncologia, Milan, Italy
| | | | - David García-Illescas
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Eudald Felip
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Ariadna Roqué Lloveras
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Rachel Sharkey
- Department of Oncology, Chelsea and Westminster Hospital, London, UK; National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Elisa Roldán
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Roxana Reyes
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Irina Earnshaw
- Cancer Division, University College London Hospitals, London, UK
| | - Daniela Ferrante
- Unit of Medical Statistics, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | | | - Isabel Ruiz-Camps
- Infectious Diseases, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Azienda Ospedaliera Maggiore Della Caritá, Novara, Italy
| | - Andrea Patriarca
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Azienda Ospedaliera Maggiore Della Caritá, Novara, Italy
| | - Riccardo Bruna
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Azienda Ospedaliera Maggiore Della Caritá, Novara, Italy
| | - Anna Sureda
- Haematology Department, ICO L'Hospitalet, Oncobell Program, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Luca Cantini
- Medical Oncology, Azienda Ospedaliero Universitaria, Ospedali Riuniti, Polytechnic University of the Marche Region, Ancona, Italy
| | | | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Lorenzo Chiudinelli
- Oncology Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Michela Franchi
- Oncology Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Krengli
- Division of Radiotherapy, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Azienda Ospedaliera Maggiore Della Caritá, Novara, Italy
| | - Armando Santoro
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain, Barcelona, Spain
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | | | - Thomas Newsom-Davis
- Department of Oncology, Chelsea and Westminster Hospital, London, UK; National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; Azienda Ospedaliera Maggiore Della Caritá, Novara, Italy
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK; Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Pinato DJ, Patel M, Scotti L, Colomba E, Dolly S, Loizidou A, Chester J, Mukherjee U, Zambelli A, Dalla Pria A, Aguilar-Company J, Bower M, Salazar R, Bertuzzi A, Brunet J, Lambertini M, Tagliamento M, Pous A, Sita-Lumsden A, Srikandarajah K, Colomba J, Pommeret F, Seguí E, Generali D, Grisanti S, Pedrazzoli P, Rizzo G, Libertini M, Moss C, Evans JS, Russell B, Harbeck N, Vincenzi B, Biello F, Bertulli R, Ottaviani D, Liñan R, Rossi S, Carmona-García MC, Tondini C, Fox L, Baggi A, Fotia V, Parisi A, Porzio G, Queirolo P, Cruz CA, Saoudi-Gonzalez N, Felip E, Roqué Lloveras A, Newsom-Davis T, Sharkey R, Roldán E, Reyes R, Zoratto F, Earnshaw I, Ferrante D, Marco-Hernández J, Ruiz-Camps I, Gaidano G, Patriarca A, Bruna R, Sureda A, Martinez-Vila C, Sanchez de Torre A, Berardi R, Giusti R, Mazzoni F, Guida A, Rimassa L, Chiudinelli L, Franchi M, Krengli M, Santoro A, Prat A, Tabernero J, Van Hemelrijck M, Diamantis N, Gennari A, Cortellini A. Time-Dependent COVID-19 Mortality in Patients With Cancer: An Updated Analysis of the OnCovid Registry. JAMA Oncol 2021; 8:114-122. [PMID: 34817562 DOI: 10.1001/jamaoncol.2021.6199] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Whether the severity and mortality of COVID-19 in patients with cancer have improved in terms of disease management and capacity is yet to be defined. Objective To test whether severity and mortality from COVID-19 among patients with cancer have improved during the course of the pandemic. Design, Setting, and Participants OnCovid is a European registry that collects data on consecutive patients with solid or hematologic cancer and COVID-19. This multicenter case series study included real-world data from 35 institutions across 6 countries (UK, Italy, Spain, France, Belgium, and Germany). This update included patients diagnosed between February 27, 2020, and February, 14, 2021. Inclusion criteria were confirmed diagnosis of SARS-CoV-2 infection and a history of solid or hematologic cancer. Exposures SARS-CoV-2 infection. Main Outcomes and Measures Deaths were differentiated at 14 days and 3 months as the 2 landmark end points. Patient characteristics and outcomes were compared by stratifying patients across 5 phases (February to March 2020, April to June 2020, July to September 2020, October to December 2020, and January to February 2021) and across 2 major outbreaks (February to June 2020 and July 2020 to February 2021). Results At data cutoff, 2795 consecutive patients were included, with 2634 patients eligible for analysis (median [IQR] age, 68 [18-77] years ; 52.8% men). Eligible patients demonstrated significant time-dependent improvement in 14-day case-fatality rate (CFR) with estimates of 29.8% (95% CI, 0.26-0.33) for February to March 2020; 20.3% (95% CI, 0.17-0.23) for April to June 2020; 12.5% (95% CI, 0.06-22.90) for July to September 2020; 17.2% (95% CI, 0.15-0.21) for October to December 2020; and 14.5% (95% CI, 0.09-0.21) for January to February 2021 (all P < .001) across the predefined phases. Compared with the second major outbreak, patients diagnosed in the first outbreak were more likely to be 65 years or older (974 of 1626 [60.3%] vs 564 of 1008 [56.1%]; P = .03), have at least 2 comorbidities (793 of 1626 [48.8%] vs 427 of 1008 [42.4%]; P = .001), and have advanced tumors (708 of 1626 [46.4%] vs 536 of 1008 [56.1%]; P < .001). Complications of COVID-19 were more likely to be seen (738 of 1626 [45.4%] vs 342 of 1008 [33.9%]; P < .001) and require hospitalization (969 of 1626 [59.8%] vs 418 of 1008 [42.1%]; P < .001) and anti-COVID-19 therapy (1004 of 1626 [61.7%] vs 501 of 1008 [49.7%]; P < .001) during the first major outbreak. The 14-day CFRs for the first and second major outbreaks were 25.6% (95% CI, 0.23-0.28) vs 16.2% (95% CI, 0.13-0.19; P < .001), respectively. After adjusting for country, sex, age, comorbidities, tumor stage and status, anti-COVID-19 and anticancer therapy, and COVID-19 complications, patients diagnosed in the first outbreak had an increased risk of death at 14 days (hazard ratio [HR], 1.85; 95% CI, 1.47-2.32) and 3 months (HR, 1.28; 95% CI, 1.08-1.51) compared with those diagnosed in the second outbreak. Conclusions and Relevance The findings of this registry-based study suggest that mortality in patients with cancer diagnosed with COVID-19 has improved in Europe; this improvement may be associated with earlier diagnosis, improved management, and dynamic changes in community transmission over time.
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Affiliation(s)
| | - David J Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Meera Patel
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Lorenza Scotti
- Department of Translational Medicine, Unit of Medical Statistics, University of Piemonte Orientale, Novara, Italy
| | - Emeline Colomba
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - Saoirse Dolly
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Angela Loizidou
- Department of Infectious Diseases, Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - John Chester
- Medical Oncology, School of Medicine, Cardiff University, Cardiff, United Kingdom.,Medical Oncology, Velindre Cancer Centre, Cardiff, United Kingdom
| | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, United Kingdom
| | - Alberto Zambelli
- Oncology Unit, Azienda Socio Sanitaria Territoriale, Papa Giovanni XXIII, Bergamo, Italy
| | - Alessia Dalla Pria
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Juan Aguilar-Company
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain.,Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Ramon Salazar
- Department of Medical Oncology, ICO L'Hospitalet, Oncobell Program, CIBERONC, Hospitalet de Llobregat, Spain
| | - Alexia Bertuzzi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Istituto di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Matteo Lambertini
- Medical Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy
| | - Marco Tagliamento
- Medical Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy
| | - Anna Pous
- Medical Oncology Department, Badalona Applied Research Group in Oncology, Institut Germans Trias i Pujol, Catalan Institute of Oncology-Badalona, Spain
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Johann Colomba
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - Fanny Pommeret
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - Elia Seguí
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Daniele Generali
- Multidisciplinary Breast Pathology and Translational Research Unit, Azienda Socio Sanitaria Territoriale, Cremona, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, Policlinico San Matteo, Pavia, Italy.,Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Gianpiero Rizzo
- Medical Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, Policlinico San Matteo, Pavia, Italy
| | - Michela Libertini
- Medical Oncology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Charlotte Moss
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Joanne S Evans
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Beth Russell
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Nadia Harbeck
- Department of Gynecology and Obstetrics, Breast Center and Gynecological Cancer Center and Comprehensive Cancer Center Munich, University Hospital Munich, Munich, Germany
| | - Bruno Vincenzi
- Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Federica Biello
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Rossella Bertulli
- Medical Oncology 2, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, Istituto Nazionale dei Tumori, Milan, Italy
| | - Diego Ottaviani
- Cancer Division, University College London Hospitals, London, United Kingdom
| | - Raquel Liñan
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Sabrina Rossi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Istituto di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - M Carmen Carmona-García
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Carlo Tondini
- Oncology Unit, Azienda Socio Sanitaria Territoriale, Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Fox
- Department of Hematology, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Alice Baggi
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Vittoria Fotia
- Oncology Unit, Azienda Socio Sanitaria Territoriale, Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandro Parisi
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giampero Porzio
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paola Queirolo
- Melanoma and Sarcoma Medical Treatment Unit, Istituto Europeo di Oncologia, Milan, Italy
| | | | - Nadia Saoudi-Gonzalez
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Eudald Felip
- Medical Oncology Department, Badalona Applied Research Group in Oncology, Institut Germans Trias i Pujol, Catalan Institute of Oncology-Badalona, Spain
| | - Ariadna Roqué Lloveras
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Thomas Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Rachel Sharkey
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Elisa Roldán
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Roxana Reyes
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | | | - Irina Earnshaw
- Cancer Division, University College London Hospitals, London, United Kingdom
| | - Daniela Ferrante
- Department of Translational Medicine, Unit of Medical Statistics, University of Piemonte Orientale, Novara, Italy
| | | | - Isabel Ruiz-Camps
- Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Andrea Patriarca
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Riccardo Bruna
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Anna Sureda
- Haematology Department, Institut Catala d'Oncologia Hospitalet, Hospitalet de Llobregat, Bellvitge Institute for Biomedical Research, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Rossana Berardi
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Polytechnic University of the Marche Region, Ancona, Italy
| | | | | | - Annalisa Guida
- Department of Oncology, Azienda Ospedaliera Santa Maria, Terni, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Istituto di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Milan, Italy
| | - Lorenzo Chiudinelli
- Oncology Unit, Azienda Socio Sanitaria Territoriale, Papa Giovanni XXIII, Bergamo, Italy
| | - Michela Franchi
- Oncology Unit, Azienda Socio Sanitaria Territoriale, Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Krengli
- Division of Radiotherapy, Department of Translational Medicine, University of Piemonte Orientale and Azienda Ospedaliera Maggiore Della Carità, Novara, Italy
| | - Armando Santoro
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Istituto di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Milan, Italy
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain.,Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Josep Tabernero
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, Baselga Oncological Institute at Quiron, Universitat de Vic - Universitat Central de Catalunya, Barcelona, Spain
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | | | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Alessio Cortellini
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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9
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Gutiérrez-Arango F, Anmella G, Hidalgo-Mazzei D, Gomes-da-Costa S, Gil-Badenes J, Marco-Hernández J, Espinosa G, Colomer L, Baldaquí N, Pujal E, Fico G, Giménez A, Verdolini N, Murru A, Vieta E, Pacchiarotti I. Bipolar disorder and Susac syndrome: a case report. Int Clin Psychopharmacol 2021; 36:305-309. [PMID: 34270507 DOI: 10.1097/yic.0000000000000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Susac-syndrome is a rare autoimmune disease that manifests with mood alterations in up to 15% of cases and is usually treated with corticosteroids. We present the case of a 41-year-old woman with a first manic episode and history of Susac-syndrome, secondary Cushing's syndrome after receiving high doses of corticosteroids and a previous depressive episode. Differentiating between primary and secondary mania is difficult, as people with bipolar disorder are prone to multiple psychiatric and nonpsychiatric comorbidities, in this case, the differential diagnosis included secondary mania, corticoid-induced manic episode and primary bipolar disorder. Upon admission, corticosteroid treatment was suspended, and the patient was started on lithium and risperidone. Secondary causes of mania were discarded and, assessing temporal and dosage criteria, it was deemed unlikely that the present episode was corticosteroid-induced. One-year outpatient follow-up pointed towards a primary bipolar type I disorder, as a separate entity from her Susac-syndrome. Corticosteroid use or abrupt withdrawal pose an underestimated risk of inducing depressive or manic symptoms, which may unmask affective disorders in susceptible individuals. Many medical conditions share CNS involvement and/or high-dose/prolonged corticosteroid treatment. In such cases, psychiatric manifestations such as mania or depression should be regarded as secondary and studied to determine the existence of medical complications before considering primary psychiatric conditions.
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Affiliation(s)
- Felipe Gutiérrez-Arango
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM
| | - Gerard Anmella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM
| | - Susana Gomes-da-Costa
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM
| | - Joaquín Gil-Badenes
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM
| | - Javier Marco-Hernández
- Autoimmune Diseases Department, Institut d'Investigacions August Pi i Sunyer, Universitat de Barcelona, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Gerard Espinosa
- Autoimmune Diseases Department, Institut d'Investigacions August Pi i Sunyer, Universitat de Barcelona, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Lluc Colomer
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM
| | - Nuria Baldaquí
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM
| | - Ester Pujal
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM
| | - Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM
| | - Anna Giménez
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM
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10
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Montes JL, De Herreros MG, Padrosa J, Zambrano TB, Zamora C, Viladot M, Fernandez-Mañas L, Gorria T, Ghiglione L, Solis ES, Chicote M, Barrera C, Font E, Fernandez-Mendez S, Téllez A, Castro P, Nicolas J, Tuca A, Prat A, Marco-Hernández J. 1726P The optimal care study: Outcomes of patients with solid malignancies admitted to intensive care unit. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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11
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Pinato DJ, Scotti L, Gennari A, Colomba-Blameble E, Dolly S, Loizidou A, Chester J, Mukherjee U, Zambelli A, Aguilar-Company J, Bower M, Galazi M, Salazar R, Bertuzzi A, Brunet J, Mesia R, Sita-Lumsden A, Colomba J, Pommeret F, Seguí E, Biello F, Generali D, Grisanti S, Rizzo G, Libertini M, Moss C, Evans JS, Russell B, Wuerstlein R, Vincenzi B, Bertulli R, Ottaviani D, Liñan R, Marrari A, Carmona-García MC, Sng CCT, Tondini C, Mirallas O, Tovazzi V, Fotia V, Cruz CA, Saoudi-Gonzalez N, Felip E, R Lloveras A, Lee AJX, Newsom-Davis T, Sharkey R, Chung C, García-Illescas D, Reyes R, Sophia Wong YN, Ferrante D, Marco-Hernández J, Ruiz-Camps I, Gaidano G, Patriarca A, Sureda A, Martinez-Vila C, Sanchez de Torre A, Rimassa L, Chiudinelli L, Franchi M, Krengli M, Santoro A, Prat A, Tabernero J, V Hemelrijck M, Diamantis N, Cortellini A. Determinants of enhanced vulnerability to coronavirus disease 2019 in UK patients with cancer: a European study. Eur J Cancer 2021; 150:190-202. [PMID: 33932726 PMCID: PMC8023206 DOI: 10.1016/j.ejca.2021.03.035] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite high contagiousness and rapid spread, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to heterogeneous outcomes across affected nations. Within Europe (EU), the United Kingdom (UK) is the most severely affected country, with a death toll in excess of 100,000 as of January 2021. We aimed to compare the national impact of coronavirus disease 2019 (COVID-19) on the risk of death in UK patients with cancer versus those in continental EU. METHODS We performed a retrospective analysis of the OnCovid study database, a European registry of patients with cancer consecutively diagnosed with COVID-19 in 27 centres from 27th February to 10th September 2020. We analysed case fatality rates and risk of death at 30 days and 6 months stratified by region of origin (UK versus EU). We compared patient characteristics at baseline including oncological and COVID-19-specific therapy across UK and EU cohorts and evaluated the association of these factors with the risk of adverse outcomes in multivariable Cox regression models. FINDINGS Compared with EU (n = 924), UK patients (n = 468) were characterised by higher case fatality rates (40.38% versus 26.5%, p < 0.0001) and higher risk of death at 30 days (hazard ratio [HR], 1.64 [95% confidence interval {CI}, 1.36-1.99]) and 6 months after COVID-19 diagnosis (47.64% versus 33.33%; p < 0.0001; HR, 1.59 [95% CI, 1.33-1.88]). UK patients were more often men, were of older age and have more comorbidities than EU counterparts (p < 0.01). Receipt of anticancer therapy was lower in UK than in EU patients (p < 0.001). Despite equal proportions of complicated COVID-19, rates of intensive care admission and use of mechanical ventilation, UK patients with cancer were less likely to receive anti-COVID-19 therapies including corticosteroids, antivirals and interleukin-6 antagonists (p < 0.0001). Multivariable analyses adjusted for imbalanced prognostic factors confirmed the UK cohort to be characterised by worse risk of death at 30 days and 6 months, independent of the patient's age, gender, tumour stage and status; number of comorbidities; COVID-19 severity and receipt of anticancer and anti-COVID-19 therapy. Rates of permanent cessation of anticancer therapy after COVID-19 were similar in the UK and EU cohorts. INTERPRETATION UK patients with cancer have been more severely impacted by the unfolding of the COVID-19 pandemic despite societal risk mitigation factors and rapid deferral of anticancer therapy. The increased frailty of UK patients with cancer highlights high-risk groups that should be prioritised for anti-SARS-CoV-2 vaccination. Continued evaluation of long-term outcomes is warranted.
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Affiliation(s)
- David J Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
| | - Lorenza Scotti
- Unit of Cancer Epidemiology, Department of Translational Medicine, CPO-Piemonte, University of Piemonte Orientale, Novara, Italy
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Emeline Colomba-Blameble
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Saoirse Dolly
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Angela Loizidou
- Department of Infectious Diseases, Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - John Chester
- Medical Oncology, School of Medicine, Cardiff University, Cardiff, UK; Medical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, UK
| | | | - Juan Aguilar-Company
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain; Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Myria Galazi
- Cancer Division, University College London Hospitals, London, UK
| | - Ramon Salazar
- Department of Medical Oncology, ICO L'Hospitalet, Oncobell Program (IDIBELL), CIBERONC, Hospitalet de Llobregat, Spain
| | - Alexia Bertuzzi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Ricard Mesia
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Johann Colomba
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Fanny Pommeret
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Elia Seguí
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Federica Biello
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Daniele Generali
- Multidisciplinary Breast Pathology and Translational Research Unit, ASST Cremona, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
| | | | - Gianpiero Rizzo
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Michela Libertini
- Medical Oncology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Charlotte Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Joanne S Evans
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Rachel Wuerstlein
- Department of Gynecology and Obstetrics, Breast Center and Gynecological Cancer Center and CCC Munich, University Hospital Munich, Munich, Germany
| | - Bruno Vincenzi
- Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rossella Bertulli
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Diego Ottaviani
- Cancer Division, University College London Hospitals, London, UK
| | - Raquel Liñan
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Andrea Marrari
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - M C Carmona-García
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | | | - Carlo Tondini
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Oriol Mirallas
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Claudia A Cruz
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Nadia Saoudi-Gonzalez
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Eudald Felip
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
| | - Ariadna R Lloveras
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Alvin J X Lee
- Cancer Division, University College London Hospitals, London, UK
| | - Thomas Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Rachel Sharkey
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Chris Chung
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - David García-Illescas
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Roxana Reyes
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | | | - Daniela Ferrante
- Unit of Cancer Epidemiology, Department of Translational Medicine, CPO-Piemonte, University of Piemonte Orientale, Novara, Italy
| | | | - Isabel Ruiz-Camps
- Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Andrea Patriarca
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Anna Sureda
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 20090 Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | | | | | - Marco Krengli
- Division of Radiotherapy, Department of Translational Medicine, University of Piemonte Orientale and Azienda Ospedaliera Maggiore Della Carita, Novara, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 20090 Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Aleix Prat
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Josep Tabernero
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - Mieke V Hemelrijck
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK; Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | | | - Alessio Cortellini
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK; Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy.
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12
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Dettorre GM, 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, Seguí E, Biello F, Generali D, Grisanti S, Seeva P, Rizzo G, Libertini M, Maconi A, Moss C, Russell B, Harbeck N, Vincenzi B, Bertulli R, Ottaviani D, Liñan R, Marrari A, Carmona-García MC, Chopra N, Tondini CA, Mirallas O, Tovazzi V, Fotia V, Cruz CA, Saoudi-Gonzalez N, Felip E, Roqué A, Lee AJX, Newsom-Davis T, García-Illescas D, Reyes R, Wong YNS, Ferrante D, Scotti L, Marco-Hernández J, Ruiz-Camps I, Patriarca A, Rimassa L, Chiudinelli L, Franchi M, Santoro A, Prat A, Gennari A, Van Hemelrijck M, Tabernero J, Diamantis N, Pinato DJ. Systemic pro-inflammatory response identifies patients with cancer with adverse outcomes from SARS-CoV-2 infection: the OnCovid Inflammatory Score. J Immunother Cancer 2021; 9:e002277. [PMID: 33753569 PMCID: PMC7985977 DOI: 10.1136/jitc-2020-002277] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with cancer 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 used inflammatory indices in SARS-CoV-2-infected patients with cancer accrued to the OnCovid study. METHODS In a multicenter cohort of SARS-CoV-2-infected patients with cancer 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 relation to oncological and COVID-19 infection features, testing their prognostic potential in independent training (n=529) and validation (n=542) sets. RESULTS We evaluated 1071 eligible patients, of which 625 (58.3%) were men, and 420 were patients with malignancy in advanced stage (39.2%), most commonly genitourinary (n=216, 20.2%). 844 (78.8%) had ≥1 comorbidity and 754 (70.4%) had ≥1 COVID-19 complication. NLR, OIS, and mGPS worsened at COVID-19 diagnosis compared with 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 to 4.20, p=0.001; adjusted concordance index score 0.611). CONCLUSIONS Systemic inflammation is a validated prognostic domain in SARS-CoV-2-infected patients with cancer and can be used 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 proinflammatory state is a putative therapeutic strategy in patients with cancer.
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Affiliation(s)
- Gino M Dettorre
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Saoirse Dolly
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Angela Loizidou
- Department of Infectious Diseases, Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - John Chester
- Medical Oncology, School of Medicine, Cardiff University, Cardiff, UK
- Medical Oncology, Velindre Cancer Centre, Cardiff, UK
| | | | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, UK
| | | | - Juan Aguilar-Company
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
- Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | | | - Ramon Salazar
- Department of Medical Oncology, ICO L'Hospitalet, Oncobell Program (IDIBELL), CIBERONC, Hospitalet de Llobregat, Spain
| | - Alexia Bertuzzi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Ricard Mesia
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Elia Seguí
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Federica Biello
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Daniele Generali
- Multidisciplinary Breast Pathology and Translational Research Unit, ASST Cremona, Cremona, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Pavetha Seeva
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Gianpiero Rizzo
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Michela Libertini
- Medical Oncology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Antonio Maconi
- Infrastruttura Ricerca Formazione Innovazione, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Charlotte Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Nadia Harbeck
- Department of Gynecology and Obstetrics, Breast Center and Gynecological Cancer Center and CCC Munich, University Hospital Munich, Munich, Germany
| | - Bruno Vincenzi
- Medical Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rossella Bertulli
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Diego Ottaviani
- Cancer Division, University College London Hospitals, London, UK
| | - Raquel Liñan
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Andrea Marrari
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - M Carmen Carmona-García
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Neha Chopra
- Cancer Division, University College London Hospitals, London, UK
| | | | - Oriol Mirallas
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | | | - Nadia Saoudi-Gonzalez
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Eudald Felip
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
| | - Ariadna Roqué
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Alvin J X Lee
- Cancer Division, University College London Hospitals, London, UK
| | - Tom Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - David García-Illescas
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Roxana Reyes
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | | | - Daniela Ferrante
- Department of Translational Medicine, Unit of Cancer Epidemiology, CPO-Piemonte, University of Eastern Piedmont, Novara, Italy
| | - Lorenza Scotti
- Department of Translational Medicine, Unit of Cancer Epidemiology, CPO-Piemonte, University of Eastern Piedmont, Novara, Italy
| | | | - Isabel Ruiz-Camps
- Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andrea Patriarca
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 20090 Pieve Emanuele, Milan, Italy
| | | | | | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 20090 Pieve Emanuele, Milan, Italy
| | - Aleix Prat
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Mieke Van Hemelrijck
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Josep Tabernero
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain
| | | | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
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Tuca A, Viladot M, Barrera C, Chicote M, Casablancas I, Cruz C, Font E, Marco-Hernández J, Padrosa J, Pascual A, Codorniu N, Román B. Prevalence of ethical dilemmas in advanced cancer patients (secondary analysis of the PALCOM study). Support Care Cancer 2020; 29:3667-3675. [PMID: 33184713 DOI: 10.1007/s00520-020-05885-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The main aim of this study was to determine the prevalence of ethical dilemmas in the end-of-life process in advanced cancer patients. METHODS We carried out a multicenter, cross-sectional, observational, prospective study in a cohort of cancer patients whose life expectancy was ≤ 6 months. We recorded sociodemographic characteristics, diagnosis of cancer, symptom burden, cognitive and functional status, emotional impact, and sociofamilial risk factors. The main outcome measure was the detection of ethical dilemmas, based on the following definition: conflict in decision-making during the end-of-life process that involves the need to choose between morally acceptable opposing options, where none is clearly preferable to another. RESULTS We included 324 patients (mean age, 69 years; 58% men). We identified 117 dilemmas in 90 patients (27.8%). The dilemmas detected were as follows: (a) conflicts of information (adaptive denial, conspiracy of silence, information exceeding patient's desired limit), 15.7%; (b) discrepancies in proportionality (discussion on futility, rejection of treatment, withdrawal of life support measures), 16.7%; (c) unrealistic expectations about the outcome of clinical trials, 2.5%; and (d) request for euthanasia or medically assisted suicide, 1.2%. We observed a greater prevalence of ethical dilemmas in men, in patients receiving active cancer treatment, and in patients with emotional distress (p < 0.05). CONCLUSIONS The prevalence of ethical dilemmas during the end-of-life process in cancer patients is relevant. Most dilemmas were associated directly or indirectly with respect for patient autonomy. In this context, the communication skills of the health professionals and advanced care planning take on a key role.
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Affiliation(s)
- Albert Tuca
- Hospital Clínic de Barcelona, Barcelona, Spain.
| | | | | | | | | | | | - Elena Font
- Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | | | - Núria Codorniu
- Fundación Atención a la Dependencia Sant Joan de Deu, Barcelona, Spain.,Nursing School of University of Barcelona, Barcelona, Spain
| | - Begoña Román
- Faculty of Philosophy of the University of Barcelona, Barcelona, Spain
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Seguí E, Auclin E, Casadevall D, Aguilar-Company J, Rodriguez M, Epaillard N, Tagliamento M, Pilotto S, López-Castro R, Mielgo X, Urbano C, Rodríguez A, García-Illescas D, Bluthgen M, Masfarré L, Oliveres H, Minatta J, Marco-Hernández J, Prat A, Mezquita L. 1714P Change of circulating pro-inflammatory markers between pre-COVID-19 condition and COVID-19 diagnosis predicts early death in cancer patients: The FLARE score. Ann Oncol 2020. [PMCID: PMC7506416 DOI: 10.1016/j.annonc.2020.08.1778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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15
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Pinato DJ, Lee AJX, Biello F, Seguí E, Aguilar-Company J, Carbó A, Bruna R, Bower M, Rizzo G, Benafif S, Carmona C, Chopra N, Cruz CA, D’Avanzo F, Evans JS, Galazi M, Garcia-Fructuoso I, Dalla Pria A, Newsom-Davis T, Ottaviani D, Patriarca A, Reyes R, Sharkey R, Sng CCT, Wong YNS, Ferrante D, Scotti L, Avanzi GC, Bellan M, Castello LM, Marco-Hernández J, Mollà M, Pirisi M, Ruiz-Camps I, Sainaghi PP, Gaidano G, Brunet J, Tabernero J, Prat A, Gennari A. Presenting Features and Early Mortality from SARS-CoV-2 Infection in Cancer Patients during the Initial Stage of the COVID-19 Pandemic in Europe. Cancers (Basel) 2020; 12:E1841. [PMID: 32650523 PMCID: PMC7408670 DOI: 10.3390/cancers12071841] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022] Open
Abstract
We describe the outcomes in cancer patients during the initial outbreak of the COVID-19 in Europe from the retrospective, multi-center observational OnCovid study. We identified 204 cancer patients from eight centers in the United Kingdom, Italy, and Spain aged > 18 (mean = 69) and diagnosed with COVID-19 between February 26th and April 1st, 2020. A total of 127 (62%) were male, 184 (91%) had a diagnosis of solid malignancy, and 103 (51%) had non-metastatic disease. A total of 161 (79%) had > 1 co-morbidity. A total of 141 (69%) patients had > 1 COVID-19 complication. A total of 36 (19%) were escalated to high-dependency or intensive care. A total of 59 (29%) died, 53 (26%) were discharged, and 92 (45%) were in-hospital survivors. Mortality was higher in patients aged > 65 (36% versus 16%), in those with > 2 co-morbidities (40% versus 18%) and developing > 1 complication from COVID-19 (38% versus 4%, p = 0.004). Multi-variable analyses confirmed age > 65 and > 2 co-morbidities to predict for patient mortality independent of tumor stage, active malignancy, or anticancer therapy. During the early outbreak of SARS-CoV-2 infection in Europe co-morbid burden and advancing age predicted for adverse disease course in cancer patients. The ongoing OnCovid study will allow us to compare risks and outcomes in cancer patients between the initial and later stages of the COVID-19 pandemic.
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Affiliation(s)
- David J. Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W12 0HS, UK;
| | - Alvin J. X. Lee
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Federica Biello
- Department of Translational Medicine, Division of Oncology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (F.B.); (F.D.); (A.G.)
| | - Elia Seguí
- Department of Medical Oncology, Hospital Clinic, 08036 Barcelona, Spain; (E.S.); (C.A.C.); (R.R.); (A.P.)
| | - Juan Aguilar-Company
- Department of Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), 08035 Barcelona, Spain; (J.A.-C.); (J.T.)
- Department of Infectious Diseases, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Anna Carbó
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, 17007 Girona, Spain; (A.C.); (C.C.); (I.G.-F.); (J.B.)
| | - Riccardo Bruna
- Department of Translational Medicine, Division of Haematology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (R.B.); (A.P.); (R.S.); (G.G.)
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London SW109NH, UK; (M.B.); (A.D.P.); (T.N.-D.)
| | - Gianpiero Rizzo
- Department of Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Sarah Benafif
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Carme Carmona
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, 17007 Girona, Spain; (A.C.); (C.C.); (I.G.-F.); (J.B.)
| | - Neha Chopra
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Claudia Andrea Cruz
- Department of Medical Oncology, Hospital Clinic, 08036 Barcelona, Spain; (E.S.); (C.A.C.); (R.R.); (A.P.)
| | - Francesca D’Avanzo
- Department of Translational Medicine, Division of Oncology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (F.B.); (F.D.); (A.G.)
| | - Joanne S. Evans
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London W12 0HS, UK;
| | - Myria Galazi
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Isabel Garcia-Fructuoso
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, 17007 Girona, Spain; (A.C.); (C.C.); (I.G.-F.); (J.B.)
| | - Alessia Dalla Pria
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London SW109NH, UK; (M.B.); (A.D.P.); (T.N.-D.)
| | - Thomas Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London SW109NH, UK; (M.B.); (A.D.P.); (T.N.-D.)
| | - Diego Ottaviani
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Andrea Patriarca
- Department of Translational Medicine, Division of Haematology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (R.B.); (A.P.); (R.S.); (G.G.)
| | - Roxana Reyes
- Department of Medical Oncology, Hospital Clinic, 08036 Barcelona, Spain; (E.S.); (C.A.C.); (R.R.); (A.P.)
| | - Rachel Sharkey
- Department of Translational Medicine, Division of Haematology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (R.B.); (A.P.); (R.S.); (G.G.)
| | - Christopher C. T. Sng
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Yien Ning Sophia Wong
- Department of Oncology, University College London Hospitals, London NW1 2PG, UK; (A.J.X.L.); (S.B.); (N.C.); (M.G.); (D.O.); (C.C.T.S.); (Y.N.S.W.)
| | - Daniela Ferrante
- Department of Translational Medicine, Unit of Cancer Epidemiology, CPO-Piemonte, University of Piemonte Orientale, 28100 Novara, Italy;
| | - Lorenza Scotti
- Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy;
| | - Gian Carlo Avanzi
- Department of Translational Medicine, Divisions of Internal and Emergency Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (G.C.A.); (M.B.); (L.M.C.); (M.P.); (P.P.S.)
| | - Mattia Bellan
- Department of Translational Medicine, Divisions of Internal and Emergency Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (G.C.A.); (M.B.); (L.M.C.); (M.P.); (P.P.S.)
| | - Luigi Mario Castello
- Department of Translational Medicine, Divisions of Internal and Emergency Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (G.C.A.); (M.B.); (L.M.C.); (M.P.); (P.P.S.)
| | | | - Meritxell Mollà
- Department of Radiation Oncology, Hospital Clinic, 08035 Barcelona, Spain;
| | - Mario Pirisi
- Department of Translational Medicine, Divisions of Internal and Emergency Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (G.C.A.); (M.B.); (L.M.C.); (M.P.); (P.P.S.)
| | - Isabel Ruiz-Camps
- Department of Infectious Diseases, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Divisions of Internal and Emergency Medicine, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (G.C.A.); (M.B.); (L.M.C.); (M.P.); (P.P.S.)
| | - Gianluca Gaidano
- Department of Translational Medicine, Division of Haematology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (R.B.); (A.P.); (R.S.); (G.G.)
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, 17007 Girona, Spain; (A.C.); (C.C.); (I.G.-F.); (J.B.)
| | - Josep Tabernero
- Department of Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), 08035 Barcelona, Spain; (J.A.-C.); (J.T.)
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, 08036 Barcelona, Spain; (E.S.); (C.A.C.); (R.R.); (A.P.)
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, 08035 Barcelona, Spain
| | - Alessandra Gennari
- Department of Translational Medicine, Division of Oncology, University of Piemonte Orientale and Maggiore della Carita’ Hospital, 28100 Novara, Italy; (F.B.); (F.D.); (A.G.)
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Fernandes Serodio J, Hernández-Rodríguez J, Espígol-Frigolé G, Alba M, Marco-Hernández J, Sánchez M, Hernández-González F, Sellarés J, Cid MC, Prieto-González S. THU0305 PREVALENCE AND CLINICAL OUTCOME OF INTERSTITIAL LUNG DISEASE IN ANCA ASSOCIATED VASCULITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Lung involvement is frequent in ANCA-associated vasculitis (AAV). Classical lung manifestations consist of capillaritis with lung haemorrhage, inflammatory infiltrates and nodules. Interstitial lung disease (ILD) is increasingly recognized among patients with AAV. However, little is known concerning risk factors and clinical course of these patients.Objectives:The aim of our study was to characterize the prevalence and clinical course of ILD in patients with AAV.Methods:We have performed a clinical retrospective single-centre observational analysis (1990-2019) of all patients with the diagnosis of microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) diagnosed according to 2018 Draft Classification Criteria for GPA and MPA1. Demographic, clinical and immunologic data were reviewed. Radiologic pattern of ILD were assessed by high-resolution-CT. Main outcome evaluated was overall-all survival.Results:The study population consisted of 123 patients, 56% female, aged 59.3±18.2 years old at the time of diagnosis. Clinical diagnosis was of MPA in 54% of patients and GPA in 46%. While 108 (88%) ANCA positive patients had PR3 (n=25) or MPO (n=83), 15 (12%) patients had negative or atypical ANCA. Any lung involvement was present in 82 (71%) and ILD was identified in 24 (20%) of all patients. ILD pattern was of usual interstitial pneumonia (UIP) in 12 patients, non-specified interstitial pneumonia (NSIP) in 9 and chronic organizing pneumonia (OP) in 3. There was an association between the presence of ILD and ANCA specificity: MPO were present in 100% of patients with UIP and in 75% of patients with NSIP/OP (p=0.017). Bronchiectasis were more prevalent among patients with ILD (19/24; p<0.001). During the median follow-up time period of 68 (23-126) months, mortality was of 42% among patients with ILD-AAV compared with 11% in no ILD-AAV (log-rank p=0.0001). On the multivariate Cox regression model, ILD was an independent predictor of mortality HR 2.95 (95%CI 1.09-7.96; p=0.033).Conclusion:ILD is a frequent manifestation of MPA and GPA patients. The presence of ILD, particularly UIP, is associated with ANCA-MPO and is a predictor of mortality. Therefore, a better management of fibrotic lung involvement in AAV is warranted.References:[1]Robson JC, Grayson PC, Ponte C, et al. Draft classification criteria for the ANCA associated vasculitides. Ann Rheum Dis 2018;77 (suppl 2):60-1.Disclosure of Interests:João Fernandes Serodio: None declared, José Hernández-Rodríguez: None declared, Georgina Espígol-Frigolé: None declared, Marco Alba: None declared, Javier Marco-Hernández: None declared, Marcelo Sánchez: None declared, Fernanda Hernández-González: None declared, Jacobo Sellarés: None declared, Maria C. Cid Grant/research support from: Kiniksa Pharmaceuticals, Consultant of: Janssen, Abbvie, Roche, GSK, Speakers bureau: Vifor, Sergio Prieto-González: None declared
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Fernandes Serodio J, Prieto-González S, Espígol-Frigolé G, Alba M, Marco-Hernández J, Cid MC, Hernández-Rodríguez J. AB0475 CLINICAL RELEVANCE OF CLINICOPATHOLOGICAL PHENOTYPE AND ANTIBODY SPECIFICITY IN ANCA-ASSOCIATED VASCULITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Classification of ANCA-associated vasculitis (AAV) has emerged in order to identify more homogenous subgroups of patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA). However, the exact value of classifying patients according to antibody specificity (proteinase 3 [PR3] or myeloperoxidase [MPO]) is still unclear.Objectives:To assess demographic, clinical and prognostic differences among subgroups of AAV patients, according to clinicopathological classification (GPAvs. MPA) and antibody specificity (PR3vs. MPO) in a single-centre cohort.Methods:A clinical retrospective (1990-2019) observational analysis was performed. Among all patients with ANCA positivity, we analysed patients with GPA and MPA diagnosed according to 2018 Draft Classification Criteria for AAV1, who were homogeneously treated and followed by the authors. Demographic, clinical and laboratory data, as well as disease outcomes, particularly BVAS, disease relapses and survival, were reviewed.Results:Among a total 140 patients with any form of AAV, 32 were excluded for a diagnosis of isolated interstitial lung disease (n=10), cocaine-induced AAV (n=3), ANCA negative or undetermined disease (n=16), atypical ANCA or double PR3/MPO positivity (n=3). Finally, 108 patients with MPA (n=66) or GPA (n=42) were included (83 MPO, 25 PR3). GPA was associated with PR3 in 55% and MPO 45% of patients. MPA was associated with MPO in 97% and PR3 in 3% of patients. GPA patients with PR3 or MPO presented with similar clinical features, disease extent and BVAS. However, compared with GPA/PR3, GPA/MPO were more frequently women (p=0.002). MPA patients presented more frequent with renal involvement (p=0.008) and GPA patients with ENT/ocular involvement (p<0.001). Patients with MPO were older (p=0.028) and more frequently women (p=0.001) than PR3 patients. When antibody specificity was compared, differences on organ-specific manifestations were less clear than between clinical phenotypes (GPA vs. MPA), and were only seen in ENT/ocular involvement (more frequent in PR3 than in MPO patients) and in muscle biopsies disclosing vasculitis (more frequent in MPO than in PR3 patients). GPA and PR3 patients presented more frequent relapsing disease than MPA and MPO patients, respectively (GPA 60% vs. MPA 36%; p=0.018 / PR3 60% vs. MPO 41%; p=0.094). While GPA tended to have a better survival rate than MPA patients (p=0.066) (Graph1), the MPO-associated disease (GPA or MPA) had clearly worse survival prognosis than PR3-AAV (p=0.008) (Graph2), similarly to what occurred in GPA-MPO (compared with GPA-PR3).Conclusion:A high proportion of GPA patients with MPO-ANCA (45%) is observed in our series. GPA is associated with a more frequent relapsing disease than MPA. MPA and presence of MPO were more frequent in females and older patients. Clinical features were similar in GPA patients with PR3 or MPO. The presence of MPO (in GPA or MPA) seems to be the main factor associated with mortality in AAV.Table 1.Symptomatology and ultrasound findings in the patients examined. PMR: Polymyalgia RheumaticaUltrasoundSymptomsCranial(n=17)PMR only(n=17)Non-specific symptoms (n=18)PMR (+) (n=7)PMR (-) (n=10)Temporal (+)7301Facial (+)2100Axilliary (+)0031References:[1]Robson JC, Grayson PC, Ponte C, et al.Draft classification criteria for the ANCA associated vasculitides. Ann Rheum Dis 2018;77 (suppl 2):60-1.Disclosure of Interests:João Fernandes Serodio: None declared, Sergio Prieto-González: None declared, Georgina Espígol-Frigolé: None declared, Marco Alba: None declared, Javier Marco-Hernández: None declared, Maria C. Cid Grant/research support from: Kiniksa Pharmaceuticals, Consultant of: Janssen, Abbvie, Roche, GSK, Speakers bureau: Vifor, José Hernández-Rodríguez: None declared
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Grafia I, Marco-Hernández J. Respuesta. Med Clin (Barc) 2020; 154:375-376. [DOI: 10.1016/j.medcli.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
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Marco-Hernández J, Prieto-González S. Classification of systemic vasculitis: Time for an update. Med Clin (Barc) 2019; 153:391-393. [PMID: 31160041 DOI: 10.1016/j.medcli.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Javier Marco-Hernández
- Servicio de Enfermedades Autoinmunes, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Sergio Prieto-González
- Servicio de Enfermedades Autoinmunes, Hospital Clínic, Universitat de Barcelona, Barcelona, España.
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Villarreal-Compagny M, Iglesias P, Marco-Hernández J, Milisenda JC, Casanova-Molla J, Hernández-Rodríguez J, Puig S, Carrera C, Prieto-González S. ANCA-associated vasculitic neuropathy during treatment with ipilimumab. Rheumatology (Oxford) 2019; 59:251-252. [DOI: 10.1093/rheumatology/kez235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | - José C Milisenda
- Department of Internal Medicine, Muscle Research Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
| | - Jordi Casanova-Molla
- Department of Neurology, EMG Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | | | - Susana Puig
- Department of Dermatology, Melanoma Unit
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
| | - Cristina Carrera
- Department of Dermatology, Melanoma Unit
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
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Hermida-Lama E, Marco-Hernández J, Medaglia AA, Pagès M, Vollmer I, Ramírez J, Martínez D, Mallolas J, García F. Cholangitis and pulmonary nodules in a clinical presentation of syphilis in an HIV-infected patient. Int J STD AIDS 2019; 30:820-824. [PMID: 31046616 DOI: 10.1177/0956462418823386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Several clinical manifestations attributed to syphilitic infection have been described in the literature. This is important because of the increased incidence of this infection mainly among men who have sex with men. We report the case of an HIV-infected patient who was hospitalized due to severe cholestasis, initially interpreted as drug-induced liver disease. It evolved slowly, with increasing intrahepatic cholangitis confirmed by magnetic resonance cholangiography and the appearance of several pulmonary nodules. In lung and liver biopsies, the presence of Treponema pallidum was detected by molecular and immunohistochemistry techniques, and a diagnosis of cholangitis and pulmonary syphilis was made.
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Affiliation(s)
- Evelyn Hermida-Lama
- 1 Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Alice Annalisa Medaglia
- 1 Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain.,2 Infectious Diseases Department, Policlinico P. Giaccone, Palermo, Italy
| | - Mario Pagès
- 3 Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ivan Vollmer
- 3 Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Josep Ramírez
- 4 Pathology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Daniel Martínez
- 4 Pathology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Josep Mallolas
- 1 Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain.,5 AIDS Research Group, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Felipe García
- 1 Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain.,5 AIDS Research Group, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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22
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Grafia I, Marco-Hernández J. Asterixis as an atypical expression of hypercalcemia. Med Clin (Barc) 2019; 152:121-122. [PMID: 29895421 DOI: 10.1016/j.medcli.2018.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Ignacio Grafia
- Servicio de Medicina Interna, Hospital Clínic de Barcelona, Barcelona, España.
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23
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Marco-Hernández J, Oliveira I, Pinazo MJ. Dolor abdominal como signo de alarma del dengue. Med Clin (Barc) 2019; 152:37-38. [DOI: 10.1016/j.medcli.2018.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 11/28/2022]
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24
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Miró Ò, Javaloyes P, Gil V, Martín-Sánchez FJ, Jacob J, Herrero P, Marco-Hernández J, Ríos J, Harjola VP, Torres-Gárate R, Alonso MI, Piñera P, Mecina AB, Escoda R, Müller C, Parissis J, Llorens P. Comparative Analysis of Short-Term Outcomes of Patients With Heart Failure With a Mid-Range Ejection Fraction After Acute Decompensation. Am J Cardiol 2019; 123:84-92. [PMID: 30360888 DOI: 10.1016/j.amjcard.2018.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/08/2018] [Accepted: 09/17/2018] [Indexed: 11/27/2022]
Abstract
To determine short-term outcomes after an episode of acute heart failure in patients with mid-range ejection fraction (40%-49%; HFmrEF) compared with patients with reduced (<40%) and preserved (>49%) ejection fractions (HFrEF and HFpEF, respectively) and according to their final destination after emergency department (ED) care. This is an exploratory, secondary analysis of the Epidemiology of Acute Heart Failure in the Emergency departments Registry, which includes consecutive acute heart failure patients diagnosed in 41 Spanish EDs. Patients with echocardiography data were included and divided into HFrEF, HFmrEF, and HFpEF. The primary outcome was 30-day all-cause mortality, and secondary outcomes were in-hospital all-cause mortality, hospital length of stay >10 days, and 30-day postdischarge ED revisit due to AHF and combined end point (ED revisit and/or death). We included 6,856 patients (age 79 [10]; 52.1% women): 21.6% had HFrEF, 14.3% HFmrEF, and 64.1% HFpEF. The main destinations for the 982 HFmrEF patients after ED management were internal medicine (293, 29.8%), cardiology (194, 19.9%) and not hospitalized (241, 24.5%), whereas the remaining 254 patients were admitted to other departments, including geriatric wards, short-stay units and intensive care units. Outcomes for HFmrEF did not differ compared with either HFrEF or HFpEF. Compared with HFmrEF admitted to cardiology, internal medicine admission or direct ED discharge increased the 30-day postdischarge ED revisit (hazard ratio [HR] 1.713, 95% confidence interval [CI] 1.042 to 2.816; and HR 1.683, 95% CI 1.046 to 2.708, respectively) and the 30-day postdischarge combined end point (HR 1.732, 95% CI 1.070 to 2.803; and HR 1.727, 95% CI 1.083 to 2.756, respectively). In conclusion, patients in the newly created HFmrEF category suffering from an acute decompensation have similar short-term outcomes as those in the classical HFrEF and HFpEF categories; nonetheless, HFmrEF patients handled in cardiology wards during decompensation obtain better outcomes, and reasons for these differences have to be unmasked and corrected.
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Affiliation(s)
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- Emergency Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
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25
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Marco-Hernández J, Camprubí D, Aylagas C, Gupta H, Castro P. Failure of intravenous artesunate treatment for Plasmodium falciparum malaria in a splenectomized traveller: A diagnostic challenge. Travel Med Infect Dis 2018; 30:142-143. [PMID: 30227244 DOI: 10.1016/j.tmaid.2018.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/04/2018] [Indexed: 11/24/2022]
Affiliation(s)
| | - Daniel Camprubí
- Department of Tropical Medicine and International Health, Hospital Clínic Barcelona, Spain; ISGlobal, Barcelona Centre for International Health Research (CRESIB), University of Barcelona, Spain
| | | | - Himanshu Gupta
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), University of Barcelona, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clínic Barcelona. IDIBAPS, Spain
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26
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Medaglia AA, Marco-Hernández J, de Ossó Acuña JT, Hermida Lama E, Martínez-Rebollar M, Caballero M, Rodríguez-Carunchio L, García F. Fusarium keratoplasticum infection in an HIV-infected patient. Int J STD AIDS 2018; 29:1039-1042. [PMID: 29629650 DOI: 10.1177/0956462418761259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fusarium infections are very rare in HIV-infected patients, even in patients in advanced stages of immunosuppression. All the reported cases in the literature are of disseminated infection, and with poor outcomes despite prompt and appropriate treatment. To the best of our knowledge, this is the first report of a localized infection with Fusarium keratoplasticum in an HIV-positive patient, successfully treated with a combination of antifungal therapy and surgical removal of the focus.
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Affiliation(s)
- Alice Annalisa Medaglia
- 1 Infectious Diseases Department, Hospital Clinic de Barcelona, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Javier Marco-Hernández
- 1 Infectious Diseases Department, Hospital Clinic de Barcelona, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Evelyn Hermida Lama
- 1 Infectious Diseases Department, Hospital Clinic de Barcelona, Hospital Clinic de Barcelona, Barcelona, Spain
| | - María Martínez-Rebollar
- 1 Infectious Diseases Department, Hospital Clinic de Barcelona, Hospital Clinic de Barcelona, Barcelona, Spain.,3 AIDS Research Group, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Miguel Caballero
- 2 Otorhinolaryngology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Felipe García
- 1 Infectious Diseases Department, Hospital Clinic de Barcelona, Hospital Clinic de Barcelona, Barcelona, Spain.,3 AIDS Research Group, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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27
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Prieto-González S, Terrades-García N, Corbera-Bellalta M, Planas-Rigol E, Miyabe C, Alba MA, Ponce A, Tavera-Bahillo I, Murgia G, Espígol-Frigolé G, Marco-Hernández J, Hernández-Rodríguez J, García-Martínez A, Unizony SH, Cid MC. Serum osteopontin: a biomarker of disease activity and predictor of relapsing course in patients with giant cell arteritis. Potential clinical usefulness in tocilizumab-treated patients. RMD Open 2017; 3:e000570. [PMID: 29299342 PMCID: PMC5743901 DOI: 10.1136/rmdopen-2017-000570] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/23/2017] [Accepted: 11/24/2017] [Indexed: 11/03/2022] Open
Abstract
Background Osteopontin (OPN) is a glycoprotein involved in Th1 and Th17 differentiation, tissue inflammation and remodelling. We explored the role of serum OPN (sOPN) as a biomarker in patients with giant cell arteritis (GCA). Methods sOPN was measured by immunoassay in 76 treatment-naïve patients with GCA and 25 age-matched and sex-matched controls. In 36 patients, a second measurement was performed after 1 year of glucocorticoid treatment. Baseline clinical and laboratory findings, as well as relapses and glucocorticoid requirements during follow-up, were prospectively recorded. sOPN and C reactive protein (CRP) were measured in 32 additional patients in remission treated with glucocorticoids or tocilizumab (interleukin 6 (IL-6) receptor antagonist). In cultured temporal arteries exposed and unexposed to tocilizumab, OPN mRNA expression and protein production were measured by reverse transcription polymerase chain reaction (RT-PCR) and immunoassay, respectively. Results sOPN concentration (ng/mL; mean±SD) was significantly elevated in patients with active disease (116.75±65.61) compared with controls (41.10±22.65; p<0.001). A significant decline in sOPN was observed in paired samples as patients entered disease remission (active disease 102.45±57.72, remission 46.47±23.49; p<0.001). sOPN correlated with serum IL-6 (r=0.55; p<0.001). Baseline sOPN concentrations were significantly higher in relapsing versus non-relapsing patients (relapsers 129.08±74.24, non-relapsers 90.63±41.02; p=0.03). OPN mRNA expression and protein production in cultured arteries were not significantly modified by tocilizumab. In tocilizumab-treated patients, CRP became undetectable, whereas sOPN was similar in patients in tocilizumab-maintained (51.91±36.25) or glucocorticoid-maintained remission (50.65±23.59; p=0.49). Conclusions sOPN is a marker of disease activity and a predictor of relapse in GCA. Since OPN is not exclusively IL-6-dependent, sOPN might be a suitable disease activity biomarker in tocilizumab-treated patients.
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Affiliation(s)
- Sergio Prieto-González
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Nekane Terrades-García
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Marc Corbera-Bellalta
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Ester Planas-Rigol
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Chie Miyabe
- Division of Rheumatology, Allergy and Immunology, Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marco A Alba
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Ariel Ponce
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Itziar Tavera-Bahillo
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Giuseppe Murgia
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Georgina Espígol-Frigolé
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Javier Marco-Hernández
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - José Hernández-Rodríguez
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Ana García-Martínez
- Department of Emergency Medicine, Hospital Clínic, University of Barcelona, IDIBAPS, CRB-CELLEX, Barcelona, Spain
| | - Sebastian H Unizony
- Division of Rheumatology, Allergy and Immunology, Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria C Cid
- Department of Autoimmune Diseases, Vasculitis Research Unit, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
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28
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Miró Ò, Tost J, Gil V, Martín-Sánchez FJ, Llorens P, Herrero P, Mebazaa A, Harjola VP, Ríos J, Marco-Hernández J, Collins SP, Peacock WF, Hollander JE, Lorca MT, Jacob J. The BRONCH-AHF study: effects on short-term outcome of nebulized bronchodilators in emergency department patients diagnosed with acute heart failure. Eur J Heart Fail 2017; 20:822-826. [PMID: 29044871 DOI: 10.1002/ejhf.1028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, Barcelona, Spain.,Medical School, University of Barcelona, Spain
| | - Josep Tost
- Emergency Department, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Barcelona, Spain
| | | | - Pere Llorens
- Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care Medicine, Hospital Lariboisière-Saint Louis, Université Paris Diderot, Paris, France
| | - Veli-Pekka Harjola
- Emergency Medicine, Helsinki University, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - José Ríos
- Laboratory of Biostatistics & Epidemiology, Universitat Autonoma de Barcelona, Medical Statistics Core Facility, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | | | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Judd E Hollander
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - María T Lorca
- Emergency Department, Hospital el Tajo, Aranjuez, Madrid, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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29
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Riera-Monroig J, Esposito FM, Marco-Hernández J. Una causa inusual de dolor abdominal: disección espontánea de la arteria mesentérica superior. Med Clin (Barc) 2017; 149:134-135. [DOI: 10.1016/j.medcli.2017.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/09/2017] [Accepted: 02/16/2017] [Indexed: 10/19/2022]
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30
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Ripoll E, Prieto-González S, Balagué O, Marco-Hernández J, Miró JM, Darnell A, Cid MC, Hernández-Rodríguez J. Occlusive vasculopathy in human immunodeficiency virus (HIV)-associated vasculitis: unusual clinical and imaging course. Clin Exp Rheumatol 2017; 35 Suppl 103:185-188. [PMID: 27974095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/29/2016] [Indexed: 06/06/2023]
Abstract
Human immunodeficiency virus (HIV)-associated vasculitis is a rare secondary systemic vasculitis involving small and medium arteries. We report a 42-year-old man with uncontrolled HIV infection presenting with long-lasting abdominal pain. An abdominal CT angiography revealed multiple microaneurysms and stenoses in intrarenal arteries, with involvement of mesenteric and hepatic arteries. HIV-associated vasculitis was diagnosed and glucocorticoids and raltegravir-based antiretroviral therapy were administered with good initial clinical and virological response. Several episodes of acute intestinal ischaemia were later developed requiring bowel resections of which histological examination showed vascular occlusive fibrotic changes without active vasculitic lesions. Vasculitis persisted in remission and intrarenal microaneurysms disappeared.
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Affiliation(s)
- Enric Ripoll
- Department of Radiology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - Sergio Prieto-González
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - Olga Balagué
- Department of Anatomic Pathology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - Javier Marco-Hernández
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - Josep M Miró
- Infectious Diseases Service; Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - Anna Darnell
- Department of Radiology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - Maria C Cid
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain.
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31
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Marco-Hernández J, Prieto-González S, Blasco M, Castro P, Cid J, Espinosa G. Thrombotic Microangiopathy: a Challenging Diagnosis Always. Isr Med Assoc J 2016; 18:437-438. [PMID: 28471571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | | | - Miquel Blasco
- Department of Nephrology and Kidney Transplant Unit, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Pedro Castro
- Department of Medical Intensive Care Unit, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Joan Cid
- Department of Hemostasis and Hemotherapy Unit, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
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