Abstract: Clinical Infection in Practice 13 (2022) 100137
Contents lists available at ScienceDirect
Clinical Infection in Practice
journal homepage: www.sciencedirect.com/journal/clinical-infection-in-practice
Case Reports and Series
Higher mortality of hospitalized haematologic patients with COVID-19
compared to non-haematologic is driven by thrombotic complications and
development of ARDS: An age-matched cohorts study☆
Ana Fernández-Cruz a, g, *, Alba Puyuelo b, Lucía Núñez Martín-Buitrago b, Enrique SánchezChica c, Carmen Díaz-Pedroche d, h, j, Rosa Ayala e, h, Manuel Lizasoain f, h, Rafael Duarte b, g, i,
Carlos Lumbreras f, h, j, Juan Antonio Vargas c, g, i
a
Infectious Diseases Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
Haematology Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
c
Internal Medicine Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
d
Internal Medicine Department, Hospital Doce de Octubre, Madrid, Spain
e
Haematology Department, Hospital Doce de Octubre, Madrid, Spain
f
Infectious Diseases Department, Hospital Doce de Octubre, Madrid, Spain
g
Fundación de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, Spain
h
Fundación para la Investigación Biomédica del Hospital Universitario, 12 de Octubre, Spain
i
Universidad Autónoma de Madrid, Spain
j
Universidad Complutense de Madrid, Spain
b
A R T I C L E I N F O
A B S T R A C T
Keywords
COVID-19
Haematologic
Outcome
Mortality
Background and Objectives: The characteristics of COVID-19 in haematologic patients compared to nonhaematologic patients have seldom been analyzed. Our aim was to analyze whether there are differences in
clinical characteristics and outcome of haematologic patients with COVID-19 as compared to non-haematologic.
Patients and methods: Retrospective cohort study in 2 University hospitals of patients admitted with laboratoryconfirmed COVID-19 included in the SEMICOVID19 database. The cohort with underlying haematologic disease
was compared to a cohort of age and date-of-COVID-19-matched controls without haematologic disease (1:2).
Results: 71 cases and 142 controls were included from March-May 2020.
Twenty (28.1%) had received recent chemotherapy. Twelve (16.9%) were stem cell transplant recipients (SCT).
Eleven (15.5%) were neutropenic concurrently with COVID-19 diagnosis.
Haematologic patients presented ARDS (58.5 vs 20.7%, p = 0.0001), thrombotic complications (15.7 vs 2.1%, p
= 0.002), DIC (5.7 vs 0.0%, p = 0.011), heart failure (14.3 vs 4.9%, p = 0.029) and required ICU admission (15.5
vs 2.8%, p = 0.001), MV (14.1% vs 2.1%, p 0.001), steroid (64.8 vs 33.1%, p = 0.0001), tocilizumab (33.8 vs
8.5%, p = 0.0001) or anakinra treatment (9.9% vs 0%, p = 0.0001) more often. In-hospital mortality was
significantly higher (38.0% vs 18.3%, p = 0.002).
Conclusions: Our results suggest COVID-19 has worse outcomes in haematologic patients than in nonhaematologic, independently of age, and that the development of ARDS and thrombotic complications drive
the higher in-hospital mortality.
Abbreviations: ARDS, acute respiratory distress syndrome; C-RP, C-reactive protein; CI, confidence interval; CLL, chronic lymphocytic leukemia; COVID-19,
Coronavirus disease 2019; DIC, disseminated intravascular coagulation; ECOG scale, Eastern Cooperative Oncology Group scale; G-CSF, granulocyte stimulating
factor; HFNC, high flow nasal cannula; ICU, Intensive Care Unit; IL6, Interleukin 6; IQR,..
{ 'indexed': {'date-parts': [[2022, 4, 22]], 'date-time': '2022-04-22T23:41:45Z', 'timestamp': 1650670905449},
'reference-count': 25,
'publisher': 'Elsevier BV',
'license': [ { 'start': { 'date-parts': [[2022, 1, 1]],
'date-time': '2022-01-01T00:00:00Z',
'timestamp': 1640995200000},
'content-version': 'tdm',
'delay-in-days': 0,
'URL': 'https://www.elsevier.com/tdm/userlicense/1.0/'},
{ 'start': { 'date-parts': [[2022, 2, 10]],
'date-time': '2022-02-10T00:00:00Z',
'timestamp': 1644451200000},
'content-version': 'vor',
'delay-in-days': 40,
'URL': 'http://creativecommons.org/licenses/by-nc-nd/4.0/'}],
'content-domain': {'domain': [], 'crossmark-restriction': False},
'published-print': {'date-parts': [[2022, 1]]},
'DOI': '10.1016/j.clinpr.2022.100137',
'type': 'journal-article',
'created': {'date-parts': [[2022, 2, 15]], 'date-time': '2022-02-15T03:43:08Z', 'timestamp': 1644896588000},
'page': '100137',
'source': 'Crossref',
'is-referenced-by-count': 0,
'title': 'Higher mortality of hospitalized haematologic patients with COVID-19 compared to '
'non-haematologic is driven by thrombotic complications and development of ARDS: An age-matched '
'cohorts study',
'prefix': '10.1016',
'volume': '13',
'author': [ {'given': 'Ana', 'family': 'Fernández-Cruz', 'sequence': 'first', 'affiliation': []},
{'given': 'Alba', 'family': 'Puyuelo', 'sequence': 'additional', 'affiliation': []},
{ 'given': 'Lucía',
'family': 'Núñez Martín-Buitrago',
'sequence': 'additional',
'affiliation': []},
{'given': 'Enrique', 'family': 'Sánchez-Chica', 'sequence': 'additional', 'affiliation': []},
{'given': 'Carmen', 'family': 'Díaz-Pedroche', 'sequence': 'additional', 'affiliation': []},
{'given': 'Rosa', 'family': 'Ayala', 'sequence': 'additional', 'affiliation': []},
{'given': 'Manuel', 'family': 'Lizasoain', 'sequence': 'additional', 'affiliation': []},
{'given': 'Rafael', 'family': 'Duarte', 'sequence': 'additional', 'affiliation': []},
{'given': 'Carlos', 'family': 'Lumbreras', 'sequence': 'additional', 'affiliation': []},
{'given': 'Juan', 'family': 'Antonio Vargas', 'sequence': 'additional', 'affiliation': []}],
'member': '78',
'reference': [ { 'issue': '3',
'key': '10.1016/j.clinpr.2022.100137_b0005',
'doi-asserted-by': 'crossref',
'first-page': '542',
'DOI': '10.1016/j.bbmt.2015.11.015',
'article-title': 'Outcomes of Influenza Infections in Hematopoietic Cell Transplant '
'Recipients: Application of an Immunodeficiency Scoring Index',
'volume': '22',
'author': 'Kmeid',
'year': '2016',
'journal-title': 'Biol Blood Marrow Transplant'},
{ 'issue': '4',
'key': '10.1016/j.clinpr.2022.100137_b0010',
'doi-asserted-by': 'crossref',
'DOI': '10.1111/tid.13105',
'article-title': 'Refinement of estimates of mortality risk using the Radiologic Severity '
'Index in hematologic malignancy patients with respiratory syncytial '
'virus infection',
'volume': '21',
'author': 'Sheshadri',
'year': '2019',
'journal-title': 'Transpl Infect Dis'},
{ 'issue': '2',
'key': '10.1016/j.clinpr.2022.100137_b0015',
'doi-asserted-by': 'crossref',
'first-page': '351',
'DOI': '10.1093/cid/ciaa1079',
'article-title': 'Are All Patients with Cancer at Heightened Risk for Severe Coronavirus '
'Disease 2019 (COVID-19)?',
'volume': '72',
'author': 'Chamilos',
'year': '2021',
'journal-title': 'Clin Infect Dis'},
{ 'issue': '1',
'key': '10.1016/j.clinpr.2022.100137_b0020',
'doi-asserted-by': 'crossref',
'DOI': '10.1186/s13045-020-00970-7',
'article-title': 'Impact of hematologic malignancy and type of cancer therapy on COVID-19 '
'severity and mortality: lessons from a large population-based registry '
'study',
'volume': '13',
'author': 'García-Suárez',
'year': '2020',
'journal-title': 'J Hematol Oncol'},
{ 'issue': '10',
'key': '10.1016/j.clinpr.2022.100137_b0025',
'doi-asserted-by': 'crossref',
'first-page': 'e737',
'DOI': '10.1016/S2352-3026(20)30251-9',
'article-title': 'Clinical characteristics and risk factors associated with COVID-19 '
'severity in patients with haematological malignancies in Italy: a '
'retrospective, multicentre, cohort study',
'volume': '7',
'author': 'Passamonti',
'year': '2020',
'journal-title': 'Lancet Haematol'},
{ 'issue': '8',
'key': '10.1016/j.clinpr.2022.100137_b0030',
'doi-asserted-by': 'crossref',
'first-page': '480',
'DOI': '10.1016/j.rce.2020.07.003',
'article-title': 'Clinical characteristics of patients hospitalized with COVID-19 in '
'Spain: Results from the SEMI-COVID-19 Registry',
'volume': '220',
'author': 'Casas-Rojo',
'year': '2020',
'journal-title': 'Rev Clin Esp'},
{ 'issue': '4',
'key': '10.1016/j.clinpr.2022.100137_b0035',
'doi-asserted-by': 'crossref',
'first-page': '424',
'DOI': '10.1182/blood-2016-08-733196',
'article-title': 'Diagnosis and management of AML in adults: 2017 ELN recommendations '
'from an international expert panel',
'volume': '129',
'author': 'Döhner',
'year': '2017',
'journal-title': 'Blood'},
{ 'issue': '27',
'key': '10.1016/j.clinpr.2022.100137_b0040',
'doi-asserted-by': 'crossref',
'first-page': '3059',
'DOI': '10.1200/JCO.2013.54.8800',
'article-title': 'Recommendations for initial evaluation, staging, and response '
'assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano '
'classification',
'volume': '32',
'author': 'Cheson',
'year': '2014',
'journal-title': 'J Clin Oncol'},
{ 'issue': '8',
'key': '10.1016/j.clinpr.2022.100137_b0045',
'doi-asserted-by': 'crossref',
'first-page': 'e328',
'DOI': '10.1016/S1470-2045(16)30206-6',
'article-title': 'International Myeloma Working Group consensus criteria for response and '
'minimal residual disease assessment in multiple myeloma',
'volume': '17',
'author': 'Kumar',
'year': '2016',
'journal-title': 'Lancet Oncol'},
{ 'issue': '6',
'key': '10.1016/j.clinpr.2022.100137_b0050',
'doi-asserted-by': 'crossref',
'first-page': '649',
'DOI': '10.1097/00000421-198212000-00014',
'article-title': 'Toxicity and response criteria of the Eastern Cooperative Oncology '
'Group',
'volume': '5',
'author': 'Oken',
'year': '1982',
'journal-title': 'AMERICAN JOURNAL OF CLINICAL ONCOLOGY'},
{ 'issue': '23',
'key': '10.1016/j.clinpr.2022.100137_b0055',
'first-page': '2526',
'article-title': 'Acute respiratory distress syndrome: the Berlin Definition',
'volume': '307',
'author': 'Force',
'year': '2012',
'journal-title': 'JAMA'},
{ 'issue': '16',
'key': '10.1016/j.clinpr.2022.100137_b0060',
'doi-asserted-by': 'crossref',
'first-page': 'e25634',
'DOI': '10.1097/MD.0000000000025634',
'article-title': 'Major determinants of death in patients hospitalized with COVID-19 '
'during the first epidemic wave in Madrid, Spain',
'volume': '100',
'author': 'Moreno-Torres',
'year': '2021',
'journal-title': 'Medicine (Baltimore)'},
{ 'issue': '6',
'key': '10.1016/j.clinpr.2022.100137_b0065',
'doi-asserted-by': 'crossref',
'first-page': '622',
'DOI': '10.1016/S2213-2600(21)00218-6',
'article-title': 'The COVID-19 puzzle: deciphering pathophysiology and phenotypes of a '
'new disease entity',
'volume': '9',
'author': 'Osuchowski',
'year': '2021',
'journal-title': 'Lancet Respir Med'},
{ 'issue': '6',
'key': '10.1016/j.clinpr.2022.100137_b0070',
'doi-asserted-by': 'crossref',
'first-page': 'R173',
'DOI': '10.1186/cc8149',
'article-title': 'Risk factors for acute respiratory distress syndrome during neutropenia '
'recovery in patients with hematologic malignancies',
'volume': '13',
'author': 'Rhee',
'year': '2009',
'journal-title': 'Crit Care'},
{ 'issue': '4',
'key': '10.1016/j.clinpr.2022.100137_b0075',
'doi-asserted-by': 'crossref',
'DOI': '10.1111/tid.13606',
'article-title': 'Immune reconstitution and severity of COVID‐19 among hematopoietic cell '
'transplant recipients',
'volume': '23',
'author': 'Malek',
'year': '2021',
'journal-title': 'Transpl Infect Dis'},
{ 'issue': '5',
'key': '10.1016/j.clinpr.2022.100137_b0080',
'doi-asserted-by': 'crossref',
'first-page': '1156',
'DOI': '10.1080/10428194.2018.1516874',
'article-title': 'Granulocyte colony-stimulating factor and respiratory status of '
'critically ill neutropenic patients with hematologic malignancies',
'volume': '60',
'author': 'Mignard',
'year': '2019',
'journal-title': 'Leuk Lymphoma'},
{ 'issue': '5',
'key': '10.1016/j.clinpr.2022.100137_b0085',
'doi-asserted-by': 'crossref',
'first-page': '319',
'DOI': '10.1038/s41577-021-00536-9',
'article-title': 'Endothelial dysfunction and immunothrombosis as key pathogenic '
'mechanisms in COVID-19',
'volume': '21',
'author': 'Bonaventura',
'year': '2021',
'journal-title': 'Nat Rev Immunol'},
{ 'issue': '8',
'key': '10.1016/j.clinpr.2022.100137_b0090',
'doi-asserted-by': 'crossref',
'first-page': '899',
'DOI': '10.1007/s00134-021-06419-w',
'article-title': 'Pulmonary immuno-thrombosis in COVID-19 ARDS pathogenesis',
'volume': '47',
'author': "O'Donnell",
'year': '2021',
'journal-title': 'Intensive Care Med'},
{ 'key': '10.1016/j.clinpr.2022.100137_b0095',
'doi-asserted-by': 'crossref',
'first-page': '24',
'DOI': '10.1016/j.blre.2018.06.002',
'article-title': 'Venous thromboembolism incidence in hematologic malignancies',
'volume': '33',
'author': 'Kekre',
'year': '2019',
'journal-title': 'Blood Rev'},
{ 'key': '10.1016/j.clinpr.2022.100137_b0100',
'doi-asserted-by': 'crossref',
'first-page': '202',
'DOI': '10.1016/j.jhin.2021.02.014',
'article-title': 'Duration of isolation and precautions in immunocompromised patients '
'with COVID-19',
'volume': '111',
'author': 'Taramasso',
'year': '2021',
'journal-title': 'J Hosp Infect'},
{ 'issue': '1',
'key': '10.1016/j.clinpr.2022.100137_b0105',
'doi-asserted-by': 'crossref',
'DOI': '10.1186/s40164-020-00177-z',
'article-title': 'Risk factors and outcome of COVID-19 in patients with hematological '
'malignancies',
'volume': '9',
'author': 'Piñana',
'year': '2020',
'journal-title': 'Exp Hematol Oncol'},
{ 'issue': '1',
'key': '10.1016/j.clinpr.2022.100137_b0110',
'doi-asserted-by': 'crossref',
'DOI': '10.1111/tid.13401',
'article-title': 'Severe COVID-19 in a patient with chronic graft-versus-host disease '
'after hematopoietic stem cell transplant successfully treated with '
'ruxolitinib',
'volume': '23',
'author': 'Saraceni',
'year': '2021',
'journal-title': 'Transpl Infect Dis'},
{ 'key': '10.1016/j.clinpr.2022.100137_b0115',
'doi-asserted-by': 'crossref',
'first-page': '100755',
'DOI': '10.1016/j.cegh.2021.100755',
'article-title': 'The use of Janus Kinase inhibitors in hospitalized patients with '
'COVID-19: Systematic review and meta-analysis',
'volume': '11',
'author': 'Wijaya',
'year': '2021',
'journal-title': 'Clin Epidemiol Glob Health'},
{ 'key': '10.1016/j.clinpr.2022.100137_b0120',
'article-title': 'BTK inhibitors for Severe Acute Respiratory Syndrome Coronavirus 2 '
'(SARS-CoV-2): A Systematic Review',
'author': 'Stack',
'year': '2021',
'journal-title': 'Res Sq'},
{ 'key': '10.1016/j.clinpr.2022.100137_b0125',
'doi-asserted-by': 'crossref',
'first-page': '154',
'DOI': '10.1016/j.ejca.2021.01.033',
'article-title': '2021 update of the AGIHO guideline on evidence-based management of '
'COVID-19 in patients with cancer regarding diagnostics, viral shedding, '
'vaccination and therapy',
'volume': '147',
'author': 'Giesen',
'year': '2021',
'journal-title': 'Eur J Cancer'}],
'container-title': 'Clinical Infection in Practice',
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'https://api.elsevier.com/content/article/PII:S259017022200005X?httpAccept=text/xml',
'content-type': 'text/xml',
'content-version': 'vor',
'intended-application': 'text-mining'},
{ 'URL': 'https://api.elsevier.com/content/article/PII:S259017022200005X?httpAccept=text/plain',
'content-type': 'text/plain',
'content-version': 'vor',
'intended-application': 'text-mining'}],
'deposited': { 'date-parts': [[2022, 4, 22]],
'date-time': '2022-04-22T23:04:49Z',
'timestamp': 1650668689000},
'score': 1,
'resource': {'primary': {'URL': 'https://linkinghub.elsevier.com/retrieve/pii/S259017022200005X'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2022, 1]]},
'references-count': 25,
'alternative-id': ['S259017022200005X'],
'URL': 'http://dx.doi.org/10.1016/j.clinpr.2022.100137',
'relation': {},
'ISSN': ['2590-1702'],
'subject': ['General Medicine'],
'container-title-short': 'Clinical Infection in Practice',
'published': {'date-parts': [[2022, 1]]},
'article-number': '100137'}
