Prognostic Factors of Coronavirus Disease 2019 In-hospital Mortality in Cancer Patients: A Retrospective Cohort Study in Taiwan.

Abstract

Aim: The coronavirus disease 2019 (COVID-19) pandemic has significantly strained global healthcare systems. Cancer patients are particularly vulnerable to adverse outcomes from COVID-19 infection. The aim of this study is to determine adverse prognostic factors in Taiwanese cancer patients who contract COVID-19.

Methods: This retrospective cohort study reviewed the medical records of patients with cancer who were admitted for a COVID-19 infection to a tertiary medical center in Taipei from 2020 to 2022 were retrospectively reviewed. The study endpoint was all-cause mortality during hospitalization. Cox regression analyses using the stepwise selection method were used to determine factors associated with survival, which included patient demographic characteristics, medical history, length of intensive care unit (ICU) stay, presence of fever at admission, microbial culture results, vaccination status, cancer types, and laboratory metrics.

Results: Forty-two patients were included in the analyses, of which 20 died. The mean age of the patients was 71 years. Stepwise regression analyses identified the following factors were risk factors for worse survival: presence of fever at admission (hazard ratio [HR] = 9.31, 95% confidence interval [CI]: 2.38-36.42, p = 0.001), higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (HR = 1.13, 95% CI: 1.05-1.23, p = 0.002), higher total bilirubin (HR = 1.15, 95% CI: 1.05-1.26, p = 0.004), and higher creatinine level (HR = 1.38, 95% CI: 1.16-1.64, p < 0.001). Higher neutrophil segment percentage and blood urea nitrogen levels showed marginally significant associations with survival.

Conclusions: Factors associated with worse survival in cancer patients who contract COVID-19 are fever at admission, high APACHE II score, and elevated levels of total bilirubin and creatinine.