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

Dettorre, G. M.; Dolly, S.; Loizidou, A.; Chester, J.; Jackson, A.; Mukherjee, U.; Zambelli, A.; Aguilar-Company, J.; Bower, M.; Sng, C. C. T.; Salazar, R.; Bertuzzi, A.; Brunet, J.; Mesia, R.; Sita-Lumsden, A.; Segui, 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.; Linan, R.; Marrari, A.; Carmen Carmona-Garcia, M.; Chopra, N.; Tondini, C. A.; Mirallas, O.; Tovazzi, V.; Fotia, V.; Cruz, C. A.; Saoudi-Gonzalez, N.; Felip, E.; Roque, A.; Lee, A. J. X.; Newsom-Davis, T.; Garcia-Illescas, D.; Reyes, R.; Wong, Y. N. S.; Ferrante, D.; Scotti, L.; Marco-Hernandez, 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, D. J.

doi:10.1136/jitc-2020-002277

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.

Systemic pro-inflammatory response identifies patients with cancer with adverse outcomes from SARS-CoV-2 infection: The OnCovid Inflammatory Score / Dettorre, G. M.; Dolly, S.; Loizidou, A.; Chester, J.; Jackson, A.; Mukherjee, U.; Zambelli, A.; Aguilar-Company, J.; Bower, M.; Sng, C. C. T.; Salazar, R.; Bertuzzi, A.; Brunet, J.; Mesia, R.; Sita-Lumsden, A.; Segui, 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.; Linan, R.; Marrari, A.; Carmen Carmona-Garcia, M.; Chopra, N.; Tondini, C. A.; Mirallas, O.; Tovazzi, V.; Fotia, V.; Cruz, C. A.; Saoudi-Gonzalez, N.; Felip, E.; Roque, A.; Lee, A. J. X.; Newsom-Davis, T.; Garcia-Illescas, D.; Reyes, R.; Wong, Y. N. S.; Ferrante, D.; Scotti, L.; Marco-Hernandez, 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, D. J.. - In: JOURNAL FOR IMMUNOTHERAPY OF CANCER. - ISSN 2051-1426. - 9:3(2021), pp. e002277."-"-e002277."-". [10.1136/jitc-2020-002277]