Cancer-Related Characteristics Associated With Invasive Mechanical Ventilation or In-Hospital Mortality in Patients With COVID-19 Admitted to ICU: A Cohort Multicenter Study

Abstract

Background: Coexistence of cancer and COVID-19 is associated with worse outcomes. However, the studies on cancer-related characteristics associated with worse COVID-19 outcomes have shown controversial results. The objective of the study was to evaluate cancer-related characteristics associated with invasive mechanical ventilation use or in-hospital mortality in patients with COVID-19 admitted to intensive care unit (ICU).

Methods: We designed a cohort multicenter study including adults with active cancer admitted to ICU due to COVID-19. Seven cancer-related characteristics (cancer status, type of cancer, metastasis occurrence, recent chemotherapy, recent immunotherapy, lung tumor, and performance status) were introduced in a multilevel logistic regression model as first-level variables and hospital was introduced as second-level variable (random effect). Confounders were identified using directed acyclic graphs.

Results: We included 274 patients. Required to undergo invasive mechanical ventilation were 176 patients (64.2%) and none of the cancer-related characteristics were associated with mechanical ventilation use. Approximately 155 patients died in hospital (56.6%) and poor performance status, measured with the Eastern Cooperative Oncology Group (ECOG) score was associated with increased in-hospital mortality, with odds ratio = 3.54 (1.60-7.88, 95% CI) for ECOG =2 and odds ratio = 3.40 (1.60-7.22, 95% CI) for ECOG = 3 to 4. Cancer status, cancer type, metastatic tumor, lung cancer, and recent chemotherapy or immunotherapy were not associated with in-hospital mortality.

Conclusions: In patients with active cancer and COVID-19 admitted to ICU, poor performance status was associated with in-hospital mortality but not with mechanical ventilation use. Cancer status, cancer type, metastatic tumor, lung cancer, and recent chemotherapy or immunotherapy were not associated with invasive mechanical ventilation use or in-hospital mortality.

Keywords: COVID-19; artificial; cancer; hospital mortality; intensive care unit; neoplasms; respiration.

Figure 1

Forest plot of cancer-related characteristics associated with invasive mechanical ventilation use (A) or in-hospital mortality (B). Data are adjusted odds ratios with 95% confidence intervals. ECOG, Eastern Cooperative Oncology Group. Panel (A) (invasive mechanical ventilation use): Cancer status, type of cancer, and performance status were adjusted for age, sex, Charlson comorbidity index and lung cancer. Recent use of chemotherapy or immunotherapy, and lung cancer were adjusted for age, sex and Charlson comorbidities index. Metastatic tumor was adjusted for age and sex. Panel (B) (in-hospital mortality): All models adjusted for age, sex, and Charlson comorbidities index.