Journal for ImmunoTherapy of Cancer (Mar 2021)

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

  • Joan Brunet,
  • Josep Tabernero,
  • Mieke Van Hemelrijck,
  • Salvatore Grisanti,
  • Bruno Vincenzi,
  • Isabel Ruiz-Camps,
  • Juan Aguilar-Company,
  • Daniela Ferrante,
  • Oriol Mirallas,
  • Amanda Jackson,
  • Beth Russell,
  • Ramon Salazar,
  • Aleix Prat,
  • Daniele Generali,
  • Nadia Harbeck,
  • Alberto Zambelli,
  • Carlo Alberto Tondini,
  • David J Pinato,
  • Lorenza Rimassa,
  • Armando Santoro,
  • Neha Chopra,
  • Tom Newsom-Davis,
  • Gino M Dettorre,
  • Saoirse Dolly,
  • Angela Loizidou,
  • John Chester,
  • Uma Mukherjee,
  • Mark Bower,
  • Christopher C T Sng,
  • Alexia Bertuzzi,
  • Ricard Mesia,
  • Ailsa Sita-Lumsden,
  • Elia Seguí,
  • Federica Biello,
  • Pavetha Seeva,
  • Gianpiero Rizzo,
  • Michela Libertini,
  • Antonio Maconi,
  • Charlotte Moss,
  • Rossella Bertulli,
  • Diego Ottaviani,
  • Raquel Liñan,
  • Andrea Marrari,
  • M Carmen Carmona-García,
  • Valeria Tovazzi,
  • Vittoria Fotia,
  • Claudia Andrea Cruz,
  • Nadia Saoudi-Gonzalez,
  • Eudald Felip,
  • Ariadna Roqué,
  • Alvin J X Lee,
  • David García-Illescas,
  • Roxana Reyes,
  • Yien Ning Sophia Wong,
  • Lorenza Scotti,
  • Javier Marco-Hernández,
  • Andrea Patriarca,
  • Lorenzo Chiudinelli,
  • Michela Franchi,
  • Alessandra Gennari,
  • Nikolaos Diamantis

DOI
https://doi.org/10.1136/jitc-2020-002277
Journal volume & issue
Vol. 9, no. 3

Abstract

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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.