Higher viral load can increase mortality in patients hospitalized with COVID-19 and cancer

Reviewed by Emily Henderson, B.Sc.September 17, 2020

Increased viral load is associated with an increased risk of death for cancer and non-cancer patients hospitalized for coronavirus disease 2019 (COVID-19), researchers reported in a journal on September 15. cancer cell..

Among hospitalized COVID-19 patients, those with hematological malignancies who have recently been treated for cancer have the highest levels of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes COVID-19. did.

As a community, we are just beginning to understand the relationship between SARS-CoV-2 viral load and outcome.“

Michael Satlin, Senior Author and Associate Professor of Infectious Diseases, Medical Center, Weill Cornell Medical Center

Satlin is also an assistant to the attending physician at the New York Presbyterian / Weil Cornell Medical Center.

“Currently, this quantitative information is not provided to the patient care team, the provider only knows if the patient’s test is positive or negative.

By providing this information to a provider of cancer patients with COVID-19, patients who receive more intensive monitoring during hospitalization and those who receive new antivirals if these treatments are inadequate. It will help you make a decision. “

COVID-19 affects more than 27 million people worldwide and kills about 900,000. The first report suggests that patients with cancer are more likely to develop more severe COVID-19 than those without cancer.

Satlin and his collaborators previously discovered that high SARS-CoV-2 viral load at the time of presentation to the emergency department was associated with in-hospital mortality in the general inpatient population. However, until now, it has not been clear how viral load at admission affects the clinical outcome of inpatients with both cancer and COVID-19.

In a new study, Satlin and his team used two standard diagnostic tests to measure the amount of SARS-CoV-2. Nasopharyngeal swab Specimens taken when admitted to three New York City hospitals between March 15 and May 14, 2020.

100 of the patients had active cancer, and 2,914 did not. Some cancer patients have solid tumors, while others are blood-based malignancies that affect blood, blood cell-producing tissues called bone marrow, lymph nodes-organs that make up part of the circulatory system or immune system. Some people have.

Half of patients with hematological malignancies had higher viral loads compared to about 30% of patients without cancer.

Only patients with hematological malignancies who received chemotherapy or targeted therapy in the last 6 months had significantly higher viral levels than general inpatients with COVID-19.

“This finding may be due to the underlying immunodeficiency brought about by either hematological malignancies or administered treatments, which may reduce the ability to inhibit the growth of SARS-CoV-2. “There is,” said co-author Lars Westblade, who was a pathologist and clinical microbiologist at Weill Cornell Medicine and a clinical microbiologist at the NewYork-Presbyterian / Weill Cornell Medical Center.

“Additional studies with large sample sizes of patients with hematological malignancies are needed to more clearly assess whether these patients had increased mortality when admitted with COVID-19.”

Overall, in-hospital mortality was 38.8% for high viral load patients, 24.1% for moderate viral load patients, and 15.3% for low viral load patients.

Cancer patients showed a similar pattern, with mortality rates of 45.2%, 28.0%, and 12.1%, respectively. High viral load in cancer patients was associated with increased in-hospital mortality than low viral load.

This finding remained statistically significant even after adjusting for factors such as age and the need for oxygen supplementation within 3 hours of presentation to the emergency department.

One important caveat is that it is unclear whether viral load predicts mortality in COVID-19 patients who are not hospitalized.

“We encourage subsequent studies to assess the potential role of using SARS-CoV-2 viral load to guide outpatient care with or without cancer.” Weill Cornell Medicine Oncology Gaku and New York-Presbyterian / Weill Cornell Medical Center Assistant Doctor.

Researchers will conduct larger studies on their own parts to see the findings and see if certain types of cancer and cancer treatments lead to increased viral load and worse results. is. We also want to evaluate whether the type and duration of treatment can be personalized by measuring the viral load of a particular patient over time.