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This retrospective cohort study identified risk factors for COVID-19 severity and outcomes in 55 patients with benign (N=3) and malignant (N=52) hematologic disorders and COVID-19 infection. The cohort mortality rate was 35%. A CRP of ≥100 mg/L was associated with a significant risk for severe COVID-19 infection (HR, 5.94) and death (OR, 5.63), albeit with relatively low to moderate sensitivity (death: 71.5%; severe disease: 65%) and specificity (death: 65.4%; severe disease:71.4%). Overall, 81% of patients required changes to treatment (delay or intensity reduction). The authors did not identify a statistically significant increase in severe infection or death in patients receiving therapy within 28 days of COVID-19 diagnosis and provide evidence of efficacy for using modified therapies in patients with ongoing COVID-19 infection requiring treatment for an underlying hematologic malignancy.
Mortality in patients with a hematological disorder and COVID-19 appears to be high (37%). An elevated CRP (≥100 mg/L) may accurately risk-stratify these patients compared with peripheral blood cytopenias, as the underlying hematologic disorder may confound the latter. The authors provide evidence of the safety and efficacy of modified treatments for patients with ongoing COVID-19 infection. Further investigation is needed to identify which patients and at what time in their disease course pursuing therapy is safe and effective.
– Curtis Lachowiez, MD
Covid-19 and blood clotting
