Haematological malignancy and nosocomial transmission are associated with an increased risk of death from COVID-19: results of a multi-center UK cohort

Figures & data

Table 1. Baseline characteristics of all patients.

Covariate		Haematological malignancy	Solid malignancy	Total	p-value
Total		52	127	179
Sex	F	16 (31%)	58 (46%)	74 (41%)
	M	36 (69%)	69 (54%)	105 (59%)	0.095
Age	Median (IQR)	71 (60.75, 76)	73 (61.5, 82)	72 (61, 81)	0.075
Ethnicity	White British	28 (54%)	47 (37%)	75 (42%)	0.28
	Black	0 (0%)	6 (5%)	6 (3%)
	South Asian	1 (2%)	2 (2%)	3 (2%)
	West Asian	1 (2%)	2 (2%)	3 (2%)
	Arab	1 (2%)	1 (1%)	2 (1%)
	East Asian	0 (0%)	2 (2%)	2 (1%)
	Latin American	0 (0%)	1 (1%)	1 (1%)
	Unknown	21 (40%)	66 (52%)	87 (49%)
Index of multiple deprivation decile	Median (IQR)	4 (1.75, 8)	3 (1, 5)	3 (1, 7)	0.039
Hypertension		15 (29%)	48 (38%)	63 (35%)	0.334
Hypercholesterolaemia		7 (13%)	22 (17%)	29 (16%)	0.284
Type II diabetes mellitus		10 (19%)	29 (23%)	39 (22%)	0.741
Dementia		1 (2%)	10 (8%)	11 (6%)	0.18
Cerebrovascular accident		1 (2%)	13 (10%)	14 (8%)	0.07
Chronic cardiac		16 (31%)	35 (28%)	51 (28%)	0.803
Chronic respiratory		11 (21%)	27 (21%)	38 (21%)	1
Chronic kidney disease		10 (19%)	22 (17%)	32 (18%)	0.93
Chronic liver		5 (10%)	6 (5%)	11 (6%)	0.371
Smoking	Active	2 (4%)	14 (11%)	16 (9%)
	Ex-smoker	25 (48%)	56 (44%)	81 (45%)
	Never	20 (38%)	52 (41%)	72 (40%)
	Unknown	5 (10%)	5 (4%)	10 (6%)	0.234

Table 2. Cancer specific information.

		Haematological malignancy, n (%)	Solid malignancy, n (%)
Time between Cancer diagnosis and COVID-19	0–3 months	12 (26%)	18 (16%)
	≥3–6 months	3 (6%)	9 (8%)
	≥6–12 months	2 (4%)	6 (5%)
	≥12–60 months	17 (36%)	36 (32%)
	≥60 months	13 (28%)	45 (39%)
Anticancer treatment
Systemic (including chemotherapy, immunotherapy, targeted, endocrine)	<4 weeks	30 (58%)	49 (39%)
	≥4 weeks to 12 months	2 (4%)	18 (14%)
	≥12 months	6 (11%)	12 (9%)
Surgical	<4 weeks	0 (0%)	3 (2%)
	≥4 weeks to 12 months	0 (0%)	5 (4%)
	≥12 months	4 (8%)	27 (21%)
Radiotherapy	<4 weeks	0 (0%)	6 (5%)
	≥4 weeks to 12 months	0 (0%)	2 (2%)
	≥12 months	2 (4%)	24 (19%)
Cancer subtypes, n (%)
Haematological malignancy (n = 52)	Lymphoid neoplasms (n = 34, 65%)	Lymphoma	14 (41%)
		Multiple myeloma	10 (29%)
		Chronic lymphocytic leukemia	10 (29%)
	Myeloid neoplasms and acute leukaemias (n = 17, 33%)	Acute myeloid leukemia	9 (53%)
		Myleodysplastic syndrome or myeloproliferative neoplasm	6 (35%)
		Acute lymphoblastic leukemia	2 (12%)
	Posttransplant lymphoproliferative disorder (n = 1, 2%)
Solid malignancy (n = 127)	Prostate	26 (20%)
	Breast	23 (18%)
	Colorectal	12 (9%)
	Lung	11 (9%)
	Bladder	9 (7%)
	Gynaecological	8 (6%)
	Skin	6 (5%)
	Hepatobiliary	6 (5%)
	Head and neck	6 (5%)
	Oesophageal	4 (3%)
	Kidney	4 (3%)
	Pancreatic	3 (2%)
	Neuroendocrine	3 (2%)
	Unknown primary	2 (2%)
	Thyroid	1 (1%)
	Mesothelioma	1 (1%)
	Gastric	1 (1%)
	Brain	1 (1%)

Figure 1. Proportions of nosocomial transmission, severity of illness and complications between HM and SM groups. (A) Pie chart with breakdown of patients with nosocomial COVID-19 along with proportion of patients who subsequently died. (B) Bar graph showing severity of illness in HM and SM groups. (C) Differences in complication rate between HM and SM groups, split by ‘medical complications’ and ‘radiological complications.’ CCF: congestive cardiac failure; VTE: venous thromboembolism; AKI: acute kidney injury; ARDS: acute respiratory distress syndrome; B/L: bilateral; Uni: unilateral; GG: ground glass; AS: airspace.

Figure 2. Overall survival of (A) HM and SM patients; (B) nosocomial COVID-19 transmission (definite or probable) and non-nosocomial infection (community acquired or indeterminate cases); (C) all cancer patients receiving systemic anticancer treatment within 4 weeks of COVID-19 and those who did not and (D) HM and SM patients who received chemotherapy within 4 weeks of COVID-19.

Table 3. Univariable and multivariable analysis of covariates grouped into demographics, cancer type and nosocomial infection, anticancer treatment and investigations with death as an outcome.

	Univariable modeling				Multivariable modeling
Covariates	n	est (se)	HR (95% CI)	p-value	est (se)	HR (95% CI)	p-value
Demographics
Sex (male vs female)	178	0.37 (0.26)	1.44 (0.868, 2.402)	0.157
Age (years)	178	0.03 (0.009)	1.03 (1.007, 1.045)	0.007	0.04 (0.014)	1.04 (1.014, 1.07)	0.003
Hypertension (yes vs no)	178	0.32 (0.251)	1.37 (0.839, 2.246)	0.208
Chronic kidney disease (yes vs no)	178	0.48 (0.295)	1.61 (0.905, 2.879)	0.105
Type II diabetes mellitus (yes vs no)	178	0.21 (0.284)	1.23 (0.704, 2.144)	0.469
Chronic cardiac (yes vs no)	178	0.4 (0.259)	1.49 (0.898, 2.474)	0.123
Chronic respiratory (yes vs no)	178	−0.1 (0.31)	0.91 (0.495, 1.671)	0.759
Index of multiple deprivation decile	121	0.04 (0.045)	1.05 (0.958, 1.142)	0.315
Ex-smokers vs active smokers	178	1.26 (0.598)	3.52 (1.09, 11.364)	0.035
Ex-smokers vs nonsmokers	178	0.71 (0.817)	2.03 (0.41, 10.059)	0.386
Cancer type and nosocomial infection
Haematological vs solid malignancy	178	1.67 (0.257)	1.82 (1.101, 3.012)	0.02	1.09 (0.321)	2.94 (1.59, 5.59)	0.001
Nosocomial infection (definite or probable)	172	0.91 (0.281)	2.47 (1.427, 4.289)	0.001
Anticancer treatment
Systemic < 4 weeks	178	−0.16 (0.251)	0.85 (0.521, 1.393)	0.522
Surgical < 4 weeks	178	0.55 (0.719)	1.74 (0.425, 7.117)	0.442
Radiotherapy < 4 weeks	178	−1.03 (1.008)	0.36 (0.05, 2.585)	0.309
Investigations
SARS-CoV-2 PCR (Cq value)	60	−0.07 (0.038)	0.94 (0.869, 1.007)	0.077
Increasing hemoglobin (g/dL)	139	−0.57 (0.614)	0.57 (0.171, 1.894)	0.357
Increasing white cell count (× 10^9/L)	139	0.01 (0.008)	1.01 (0.996, 1.026)	0.165
Increasing neutrophil count (× 10^9/L)	138	0.03 (0.027)	1.03 (0.977, 1.088)	0.27
Increasing lymphocyte count (× 10^9/L)	139	0.03 (0.226)	1.03 (0.663, 1.609)	0.885
Increasing platelet count (× 10^9/L)	139	−0.36 (0.142)	0.7 (0.529, 0.923)	0.012	−0.3 (0.146)	0.74 (0.554, 0.982)	0.037
Increasing C-reactive protein (mg/L)	131	0.34 (0.138)	1.41 (1.073, 1.846)	0.013	0.29 (0.15)	1.34 (0.998, 1.796)	0.052
Increasing sodium (mmol/L)	137	0.01 (0.034)	1.01 (0.94, 1.075)	0.878
Increasing potassium (mmol/L)	135	−0.56 (0.29)	0.57 (0.323, 1.008)	0.053

Covariates which had a p-value <0.25 were included in the multivariable modeling.

p-values <0.05 are highlighted in bold.

Figure 3. Risk of death relating to nosocomial infection, type of malignancy and whether chemotherapy was received within 4 weeks of COVID-19. The color codes signify the risk of death. HM: haematological malignancy; SM: solid malignancy. HM and SM groups refer to all patients who did not receive chemotherapy within 28 days of COVID-19.