Systemic inflammation ID’d as mortality marker for COVID-19 in cancer patients

Several markers of inflammation hold clue to identifying cancer patients at increased risk of death from COVID-19, according to data from OnCovid reported during the European Society for Medical Oncology (ESMO) Asia Virtual Congress.

“Systemic inflammation is a key driver of mortality from SARS-CoV-2 in cancer patients,” according to presenting author Gino Dettorre, MRes, from the Imperial College London – Hammersmith Hospital in UK.

“The neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI), modified Glasgow prognostic score (mGPS), and prognostic index (PI) are externally validated biomarkers to quantify systemic inflammation in patients with cancer and can be used as bedside tests to stratify [those] at risk of poorer outcome from COVID-19,” Dettorre added.

OnCovid retrospectively collected medical records of 1,318 consecutive adult cancer patients with COVID-19 from multiple academic centres in UK, Spain, Italy, Germany, and Belgium. Patients with leukaemia, myeloma, or insufficient data were excluded.

Dettorre and colleagues looked at 1,071 patients and grouped them into two: training cohort (n=529) and validation cohort (n=542). Patient characteristics were similar in the two cohorts: age (mean, 67.9 and 68.5 years, respectively), active malignancy at COVID-19 diagnosis (66.7 percent vs 61.6 percent), presence of more than one comorbidity (52.1 percent vs 49.8 percent), and prevalence of complications including respiratory failure (58.0 percent and 59.0 percent) and acute respiratory distress syndrome (ARDS; 11.5 percent and 12.9 percent). [ESMO Asia 2020, abstract 319O]

Evaluation of biomarkers in the training cohort revealed significant associations with the risk of death. Mortality rates were elevated among patients with NLR >6 (44.6 percent vs 28 percent; p<0.0001), PNI <40 (46.6 percent vs 20.9 percent; p<0.0001), mGPS2 (50.6 percent vs 30.4 percent for mGPS1 and 11.4 percent for mGPS0; p<0.0001), and PI2 (50 percent vs 40 percent for PI1 and 9.1 percent for PI0; p<0.0001). There was no significant difference in survival noted for platelet-to-lymphocyte ratio.

According to Dettorre, median overall survival (OS) was short among patients in poor risk categories (NLR >6: 30 days, 95 percent confidence interval [CI], 1–63; PNI <40: 23 days, 95 percent CI, 10–35; mGPS2: 20 days, 95 percent CI, 8–32; PI2: 23 days, 95 percent CI, 1–56). In comparison, median OS was not reached among patients in good risk categories (p<0.0001 for all).

Analyses of survival in the validation cohort confirmed that NLR, PNI, PI, and mGPS predicted survival (p<0.0001).

Finally, multivariable hazard ratio calculations and Harrell's C-index computation showed that patients with a poor risk PNI, a computation derived from hypoalbuminaemia and lymphocytopaenia, proved most susceptible to severe COVID-19 (training cohort: hazard ratio [HR], 1.97, 95 percent CI, 1.19–3.26; p=0.008; validation cohort: HR, 2.48, 95 percent CI, 1.47–4.20; p=0.001), Dettorre noted.

“The mGPS (calculated via C-reactive protein levels and hypoalbuminaemia), PI (calculated via C-reactive protein levels and leukocytosis), and NLR (the ratio of neutrophils to lymphocytes) emerged as most to least predictive of fatal COVID-19, respectively,” he added.

Explaining the results, Dettorre pointed to systemic inflammation as a unifying mechanism common to cancer progression and SARS-CoV-2 infection.

“Mortality from COVID-19 strongly relates to systemic inflammatory reaction to SARS-CoV-2,” and the present data show just that, he added.