Systemic pro-inflammatory response identifies patients with cancer with adverse outcomes from SARS-CoV-2 infection: the OnCovid Inflammatory Score
Authors: Dettorre Gino M , Dolly Saoirse , Loizidou Angela , Chester John , Jackson Amanda , Mukherjee Uma , Zambelli Alberto , Aguilar-Company Juan , Bower Mark , Sng Christopher C T , Salazar Ramon , Bertuzzi Alexia , Brunet Joan , Mesia Ricard , Sita-Lumsden Ailsa , Seguí Elia , Biello Federica , Generali Daniele , Grisanti Salvatore , Seeva Pavetha , Rizzo Gianpiero , Libertini Michela , Maconi Antonio , Moss Charlotte , Russell Beth , Harbeck Nadia , Vincenzi Bruno , Bertulli Rossella , Ottaviani Diego , Liñan Raquel , Marrari Andrea , Carmona-García M Carmen , Chopra Neha , Tondini Carlo Alberto , Mirallas Oriol , Tovazzi Valeria , Fotia Vittoria , Cruz Claudia Andrea , Saoudi-Gonzalez Nadia , Felip Eudald , Roqué Ariadna , Lee Alvin J X , Newsom-Davis Tom , García-Illescas David , Reyes Roxana , Wong Yien Ning Sophia , Ferrante Daniela , Scotti Lorenza , Marco-Hernández Javier , Ruiz-Camps Isabel , Patriarca Andrea , Rimassa Lorenza , Chiudinelli Lorenzo , Franchi Michela , Santoro Armando , Prat Aleix , Gennari Alessandra , Van Hemelrijck Mieke , Tabernero Josep , Diamantis Nikolaos , Pinato David J 
Published: March 2021

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.