Initial report on hospitalized cancer patients with COVID-19 from the National Cancer Institute (NCI) COVID-19 in Cancer Patients Study (NCCAPS).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6566-6566
Author(s):  
Nicholas M. Mark ◽  
Ana F. Best ◽  
Alok A. Khorana ◽  
Steven Pergam ◽  
Grace E. Mishkin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Mechanical Ventilation ◽  
Cancer Patients ◽  
Clinical Data ◽  
Invasive Mechanical Ventilation ◽  
Hematologic Malignancies ◽  
Initial Report ◽  
Discharge Data ◽  
Presenting Symptoms ◽  
High Dependency

6566 Background: Hospitalized cancer patients (pts) with COVID-19 have a severe disease course and high mortality. Pts with lung cancer, hematologic malignancies and metastatic disease may be at higher risk. Detailed prospective inpatient data may help to identify those at greatest risk for poor outcomes. Methods: NCCAPS is a longitudinal study aiming to accrue 2,000 cancer pts undergoing treatment for hematologic malignancy or solid tumor with COVID-19. For pts’ first COVID-19 hospitalization, clinical data, research blood specimens and imaging are collected, and additional clinical data are collected during subsequent hospitalizations. Results: As of Jan. 22, 2021, among 757 enrolled adult patients from 204 sites, 124 (16.3%) reported at least one hospitalization for COVID-19, and discharge data was available for 98 hospitalizations in 88 patients. The median age was 67 (range 21-93, 1Q:56, 3Q:72), 35/88 (40%) were female. The most common malignancies in hospitalized adult pts were lymphoma (18.2%), lung cancer (15.9%) and multiple myeloma (10.2%). The most common presenting symptoms were shortness of breath (65%), fatigue/malaise (64%), and fever (49%). 8/88 (9%) pts were neutropenic (ANC < 1000) at presentation; 17/88 (19%) were thrombocytopenic. Median length of stay was 6.5 days (range 1-41, 1Q:4, 3Q:12). Among those hospitalized, 20/88 (22.7%) received care in the ICU or high dependency unit, with a median ICU stay of 7 days (range 1-22, 1Q:2.5, 3Q:9.5); of those admitted to the ICU, 25% (5/20) received invasive mechanical ventilation. Of those in whom inpatient medications were recorded (n = 63), 63% received corticosteroids, 46% received remdesivir, and 14% received convalescent plasma. One pt received bamlanivimab and 2 patients received tocilizumab. Most (46/63; 73%) received anticoagulation, primarily prophylactic low molecular weight heparin; 11/63 (17%) received therapeutic dose anticoagulation. Inpatient D-dimer values were recorded in 43 inpatients, 26 of whom had multiple measurements. 16/98 hospitalizations ended with death (16%). Conclusions: Preliminary analysis of NCCAPS data reveals that inpatient hospital admission is common among oncology patients with COVID-19 and mortality rates appear high within this cohort. Hematologic malignancies and lung cancer are the most common underlying diagnoses in patients requiring hospitalization. Corticosteroids and anti-coagulation were the most commonly used therapies. Despite high rates of ICU admission, invasive mechanical ventilation may be instituted less often in an oncology cohort. These observations may inform decisions about vaccine policy and decisions to limit life sustaining treatment. Clinical trial information: NCT04387656.

scholarly journals The role of Continuous Positive Airway Pressure (CPAP) in Delaying or Avoiding Mechanical Ventilation in COVID-19 Respiratory Failure: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Allan Cameron ◽  
Sharif Fattah ◽  
Laura Knox ◽  
Pauline Grose
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Royal Infirmary ◽  
High Dependency ◽  
Number Of Patients

Abstract Background - During the winter of 2020-2021, the second wave of the COVID19 pandemic in the United Kingdom caused increased demand for intensive care unit (ICU) beds, and in particular, for invasive mechanical ventilation (IMV). To alleviate some of this pressure, some centres offered non-invasive continuous positive airway pressure (CPAP), delivered on specialised COVID high dependency units (cHDUs). However, this practice was based largely on anecdotal reports, and it is not clear from the literature how effective CPAP is at delaying or preventing IMV. Methods - This was a retrospective observational cohort study of consecutive patients admitted to a specialised cHDU at Glasgow Royal Infirmary between November 2020 and February 2021. Each patient had a continuous record of the level of respiratory support required, and was followed up to hospital discharge or death. We examined patient outcomes according to age, sex and maximum level of respiratory support, using logistic regression and time-to-event analysis. The number of patients who could not be oxygenated by standard oxygen facemask but could be oxygenated by CPAP was counted and compared to the number of patients admitted to ICU for IMV over the same period.Results - There were 152 admissions to cHDU over the study period. Of these, 125 received CPAP treatment. Of the patients who received support in cHDU, the overall mortality rate was 37.9% (95% CI 30.3% - 46.1%)). Odds of mortality were closely correlated with increasing age and oxygen requirement. Of the 152 patients, 44 patients (28.8%, 95% CI 22.0 – 36.9%) went on to require IMV in ICU. This represents 77.2% of the 57 COVID-19 admissions to ICU during the same period. However, there were also 41 patients who received levels of respiratory support on cHDU which would normally necessitate ICU admission but who never went to ICU, potentially reducing ICU admissions by 41.8% (95% CI 32.1 – 52.2%).Conclusion - Providing respiratory support in cHDU reduced the number of potential ICU admissions by 41.8%, as well as delaying IMV for over 75% of ICU admissions. This represents a significant sparing of ICU capacity at a time when IMV beds were in high demand.

scholarly journals Outcome of lung cancer patients with acute respiratory failure requiring mechanical ventilation

2004 ◽  
Vol 98 (1) ◽  
pp. 43-51 ◽  
Author(s):  
Yu-Ching Lin ◽  
Ying-Huang Tsai ◽  
Chung-Chi Huang ◽  
Kuang-Huang Hsu ◽  
Szu-Wei Wang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Cancer Patients ◽  
Lung Cancer Patients

scholarly journals 518. Factors Associated with Severe COVID-19 among Patients Hospitalized in Rhode Island

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S324-S325
Author(s):  
Aakriti Pandita ◽  
Fizza S Gillani ◽  
Yiyun Shi ◽  
Anna hardesty ◽  
Jad Aridi ◽  
...  
Keyword(s):  
Rhode Island ◽  
Clinical Data ◽  
Severe Disease ◽  
Academic Medical Center ◽  
Invasive Mechanical Ventilation ◽  
Low Flow ◽  
Categorical Variables ◽  
Nursing Facility ◽  
Presenting Symptoms ◽  
Severe Group

Abstract Background To better understand patient factors that impact clinical outcomes in COVID-19, we performed a retrospective cohort study of patients hospitalized with COVID-19 in Rhode Island to identify patient and clinical characteristics associated with severe disease. Methods We analyzed 259 patients admitted to our academic medical center during a three month period with confirmed COVID-19. Clinical data was extracted via chart review and lab results within the first 24 hours of admission were extracted directly from electronic medical records. Patients were divided in two groups based upon the highest level of supplemental oxygen (O2) required during hospitalization: severe COVID-19 (high flow O2, non-invasive, or invasive mechanical ventilation) and non-severe COVID-19 (low flow O2 or no supplemental O2). SAS 9.4 (Cary, NC) was used for statistical analyses. Chi-square or Fisher’s exact tests for categorical variables and the Student’s t-test for continuous variables were used to compare demographics, baseline comorbidities, and clinical data between the severe and non-severe groups. Table 1: Demographics Results Of 259 patients, 166 (64%) had non-severe disease, and 93 (36%) severe disease; median age [IQR] was 62 [51,73]. There were 138(53%) males and 75 (29%) Hispanics. Among non-Hispanics,124(48%) were White, 48(19%) African Americans, and 12(5%) other races. Sixty (23%) were admitted from a nursing facility and the in-hospital mortality rate was 15% (38/259). Severe COVID-19 was associated with older age (p=0.02), admission from nursing facility (p=0.009), increased BMI (p=0.03), diabetes mellitus (p=0.0002), and COPD (p=0.03). At the time of presentation, severe COVID-19 was associated with tachypnea, hypoxia, hypotension (all p&lt; 0.0001), elevated BUN (p=0.002) and AST (p=0.001), and acute or chronic kidney injury (p=0.01). Median hospital stay [IQR] was 11 days [7,18] in the severe vs. 6 days [3,11] in the non-severe group. In the severe group, 72% required ICU admission and 39% died. Table 2: Medical comorbidities Table 3: Presenting symptoms and signs in the first 48 hours of admission Table 4: Basic labs in the first 24 hours Conclusion In this cohort of patients with COVID-19, specific comorbidities, and vital signs at presentation were associated with severe COVID-19. These findings help clinicians with early identification and triage of high risk patients. Disclosures All Authors: No reported disclosures

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