Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome
Rebecca Lee, Oskar Wysocki, Talvinder Bhogal, Rohan Shotton, Ann Tivey, Angelos Angelakas, Theingi Aung, Kathryn Banfill, Mark Baxter, Hannah Boyce, Gillian Brearton, Ellen Copson, Emmy Dickens, Leonie Eastlake, Fábio Gomes, Christina J. Hague, M. Harrison, Laura Horsley, Prerana Huddar, Zoe Hudson, Sam Khan, Umair Khan, Alec Maynard, Hayley McKenzie, Daniel H. Palmer, Tim Robinson, Michael Rowe, Anne Thomas, John Tweedy, R. Sheehan, Alexander Stockdale, Jamie Weaver, Sophie Williams, Caroline Wilson, Congyang Zhou, Caroline Dive, Tim Cooksley, Carlo Palmieri, André Freitas, Anne Armstrong
Abstract
BACKGROUND: Cancer patients are at increased risk of death from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer and its treatment affect many haematological and biochemical parameters, therefore we analysed these prior to and during coronavirus disease 2019 (COVID-19) and correlated them with outcome. PATIENTS AND METHODS: Consecutive patients with cancer testing positive for SARS-CoV-2 in centres throughout the United Kingdom were identified and entered into a database following local governance approval. Clinical and longitudinal laboratory data were extracted from patient records. Data were analysed using Mann-Whitney U test, Fisher's exact test, Wilcoxon signed rank test, logistic regression, or linear regression for outcomes. Hierarchical clustering of heatmaps was performed using Ward's method. RESULTS: ) or death. Lymphocyte count (P < 0.001), platelet count (P = 0.03), LDH (P < 0.0001) and albumin (P < 0.0001) significantly changed from preinfection to during infection. High rather than low neutrophils at day 0 (P = 0.007), higher maximal neutrophils during COVID-19 (P = 0.026) and higher neutrophil-to-lymphocyte ratio (NLR; P = 0.01) were associated with death. In multivariable analysis, age (P = 0.002), haematological cancer (P = 0.034), C-reactive protein (P = 0.004), NLR (P = 0.036) and albumin (P = 0.02) at day 0 were significant predictors of death. In the Manchester/Liverpool cohort 30 patients have restarted therapy following COVID-19, with no additional complications requiring readmission. CONCLUSION: Preinfection biochemical/haematological parameters were not associated with worse outcome in cancer patients. Restarting treatment following COVID-19 was not associated with additional complications. Neutropaenia due to cancer/treatment is not associated with COVID-19 mortality. Cancer therapy, particularly in patients with solid tumours, need not be delayed or omitted due to concerns that treatment itself increases COVID-19 severity.