Determinants of COVID-19 Disease Severity in Patients With Cancer

Prognosis Transversal
Robilotti EV et al
Nature Med

Main result

423 cancer patients diagnosed with COVID-19 (56% were over the age of 60, 59% had a pre-existing comorbidity other than cancer).

In the cohort, 168 (40%) were hospitalized and 87 (20%) developed severe respiratory disease, of which 47 (11%) required high-flow oxygen and 40 (9%) required mechanical ventilation. The disease in 7 pediatric patients was mild and uncomplicated.

The overall case fatality rate was 12% (51 of 423). The number of deaths for hospitalized patients and in intensive care units was 24% (41 of 168) and 35% (17 of 48), respectively.

In the multivariate analysis, the following risk factors were independently associated with hospitalization and with a severe form of the infection: non-Caucasian ethnic origin, hematological malignancy, a composite criterion as chronic lymphopenia and / or use of corticosteroids and immunotherapy by checkpoint inhibitor (anti-CTLA-4, anti-PD-1, anti-PD-L1).

Post-hoc analysis on checkpoint inhibitors: distinct effects of lung cancer and treatment on hospitalization and severe forms.


Cancer patients with COVID-19 were often hospitalized (40%) and the outcomes were often severe (20% severe) or even fatal (12% died within 30 days). An association has been observed between checkpoint inhibitor immunotherapy and severe COVID-19 outcomes.

Strength of evidence Weak

Letter to the Editor
A monocentric retrospective cohort study
Retrospective, unblinded data collection from medical records, no details on multiple data entry and data verification


Report the epidemiology of COVID-19 in a tertiary cancer center in New York and analyze the risk factors for severe SARS-CoV-2 infection for cancer patients.


Retrospective cohort study of patients with cancer diagnosed COVID-19, monocentric (New York).

Inclusion criteria: from March 10 to April 7, 2020, all consecutive cases (adults and pediatric) with cancer and COVID-19 (symptomatic and confirmed) in the laboratory were included. Follow-up period of at least 30 days in the absence of death in the meantime.

Exclusion criteria: outpatients with missing clinical information and asymptomatic individuals tested under diagnostic screening protocols before surgery or myeloablative chemotherapy were excluded.

Data were collected in electronic medical records.

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