P1009: PREDICTORS OF HOSPITALIZATION AND SEVERE OUTCOMES IN PATIENTS WITH MPN AND COVID-19
HemaSphere, vol. 6, pp. 899–900
Abstract
Background: Risk factors for severe COVID-19 in myeloproliferative neoplasms (MPN) have been extensively explored. However, no information is available on risk factors to hospitalization at COVID-19 diagnosis. Aims: To provide an evidence-based triage and inform for a timely and antiviral therapy prescription in early phases of viral replication. Methods: The MPN-COVID study is still enrolling consecutive adult MPN patients with COVID-19 infection since February 15, 2020. Among 479 patients (ET n=175, PV n=158, MF n=91, and pre-PMF n=55) with COVID-19 from Feb 2020 to Jun 2021, 248 (52%) were managed at home and 231 (48%) were hospitalized. Results: Univariate analysis Compared to outpatients, those admitted to hospital were more likely to be men (58.9% vs. 45.2%, p=0.003), older than 70 years (61.3% vs. 29.0%, p<.001), with at least one comorbidity (79.7% vs. 55.5%, p<.001) and a history of thrombosis (26.5% vs. 16.6%, p=0.008). Overt myelofibrosis (MF) cases were more frequent in hospital (38.5% vs. 18.1%, p<.001) than PV, ET or pre-PMF. Ruxolitinib was more frequently used in patients who underwent to hospital than managed at home. (25.7% vs. 12.1%, p<.001). In comparison with outpatients, hospitalized cases had a significantly lower median values of hemoglobin (12.1 vs. 13.3 g/dL, p<.001), platelets (250 vs. 390 x109/L, p<.001), absolute lymphocytes (0.8 vs. 1.4 x109/L, p<.001) and higher neutrophil counts (5.1 vs. 4.5 x109/L, p=0.022), leading to a significant increase of neutrophil to lymphocyte ratio (NLR) (6.6 vs. 3.2, p<.001). Compared to lymphocytopenia, the best sensitivity and specificity was found for NLR, whose AUC was 77.28% by ROC analysis. Multivariate analysis By adjusting for sex, comorbidity, fever, systemic symptoms, O2 saturation, previous thrombosis, MPN type, ruxolitinib exposure, and first vs. subsequent waves and vaccination period, three factors emerged as independent predictors of hospitalization: age over 70 years, (OR=3.02, p=0.038), dyspnea (OR=7.23, p<.001) and NLR ≥4, (OR=6.94, p<.001). Interaction model of risk factors In a model fitted to test the interaction terms of the three significant variables, we evaluated the marginal effect of NLR and dyspnea across different age classes (Figure) and found that in younger patients (i.e., from 50 to 70 years) dyspnea was the stronger predictor than increased NLR; conversely, both dyspnea and NLR showed a high and comparable marginal effect in age >80 years. Remarkably, the probability of hospitalization consistently exceeded 90% for any age group when dyspnea and NLR were concomitantly present, and their combination was more prevalent in MF (42%) than in the other phenotypes (24%, 25% and 29% in pre-PMF, PV and ET patients, respectively). In addition to predict hospitalization, dyspnea and NLR≥4 were also associated with severity of COVID-19 illness in terms of respiratory support at hospitalization (OR=2.44, p=0.023). Of note, only age >70 years and NLR higher than 6 were predictors of survival in hospitalized patients (OR=3.24, p=0.007 and OR=5.41, p=0.041, respectively). Image:Summary/Conclusion: For triage purposes of MPN patients tested positive for COVID-19, dyspnea, age and NLR are powerful predictors of hospitalization and identify patients at higher probability of invasive or non-invasive respiratory support and survival, particularly in overt MF. This MPN subgroup at high risk for progression to severe COVID-19 disease should be prioritized for antiviral therapy, even in the ambulatory setting.
Authors 51
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T. Barbui corresponding
FROM – Fondazione per la Ricerca Ospedale di Bergamo ETS
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FROM Research Foundation, Bergamo
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FROM – Fondazione per la Ricerca Ospedale di Bergamo ETS
Affiliation as printed
FROM Research Foundation, Bergamo
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FROM – Fondazione per la Ricerca Ospedale di Bergamo ETS
Affiliation as printed
FROM Research Foundation, Bergamo
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Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Affiliation as printed
Hematology division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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University of Wrocław · Wroclaw Medical University
Affiliation as printed
Department of Hematology, Blood neoplasms and Bone marrow transplantation, Wroclaw Medical University, Wroclaw, Poland
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Azienda Ospedaliera San Gerardo
Affiliation as printed
Hematology division and Bone marrow transplant unit, San Gerardo Hospital, ASST Monza, Monza
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Affiliation as printed
Department of Molecular medicine, University of Pavia, Pavia
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Agostino Gemelli University Polyclinic · Istituti di Ricovero e Cura a Carattere Scientifico
Affiliation as printed
Fondazione Policlinico “A. Gemelli” IRCCS, Rome
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Affiliation as printed
IRCCS Ospedale San Raffaele, Milan
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Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo
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AOU SS. Antonio e Biagio e C. Arrigo, Alessandria
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Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia
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ASST Spedali Civili, Brescia, Italy
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Affiliation as printed
Hospital Univeristario La Paz, Madrid
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Hospital Universitario de Burgos
Affiliation as printed
Hospital Universitario de Burgos, Burgos
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Vall d'Hebron Hospital Universitari · Vall d'Hebron Institute of Oncology
Affiliation as printed
Department of Hematology, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus
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Affiliation as printed
Hospital del Mar, Barcelona, Spain
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IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola
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IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
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University of Florence · Azienda Ospedaliero-Universitaria Careggi
Affiliation as printed
Center Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Department of Experimental and Clinical Medicine, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence
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Azienda Ospedaliera Citta' della Salute e della Scienza di Torino
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AOU Città della Salute e della Scienza di Torino, Torino, Italy
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Guy's and St Thomas' NHS Foundation Trust
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Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
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Hospital Universitario Infanta Leonor
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Hospital Universitario Infanta Leonor, Madrid, Spain
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Affiliation as printed
Ospedale Policlinico “G.B. Rossi”, Borgo Roma, Verona, Italy
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Affiliation as printed
Hospital Clinic de Barcelona, Barcelona, Spain
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Affiliation as printed
Hospital Saint-Louis, Paris, France
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Affiliation as printed
Hospital Clinico San Carlos, Madrid, Spain
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Azienda Ospedaliero Universitaria Maggiore della Carita
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AOU Maggiore della Carità, Novara, Italy
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Hospital Universitario de Móstoles
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Hospital Universitario de Mostoles, Madrid, Spain
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Johannes Wesling Klinikum Minden
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University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center, Minden, Germany
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Instituto Ramón y Cajal de Investigación Sanitaria · Hospital Universitario Ramón y Cajal
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Hospital Ramon y Cajal, IRYCIS, Madrid
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Hospital General Universitario de Albacete · Complejo Hospitalario Universitario de Albacete
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Hospital General Universitario de Albacete, Albacete
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Hospital Universitario Príncipe de Asturias
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Hospital Universitario Principe de Asturias, Alcalà de Henares, Madrid, Spain
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Affiliation as printed
Ospedale San Bortolo, Vicenza, Italy
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INCLIVA Health Research Institute · Hospital Clínico Universitario de Valencia
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Hospital Clinico Universitario, INCLIVA, Valencia
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Hospital General Universitario Gregorio Marañón
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Hospital Gregorio Maranon
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Hospital de Sant Joan Despí Moisès Broggi · Institut Català d'Oncologia
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ICO L’Hospitalet-Hospital Moises Broggi, Sant Joan Despì, Barcelona, Spain
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University of Zagreb · University Hospital Dubrava
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Department of haematology, Clinic of internal medicine, University Hospital Dubrava-School of Medicine University of Zagreb, Zagreb, Croatia
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Affiliation as printed
Hospital Moncloa, Madrid
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Hospital Universitari de Girona Doctor Josep Trueta
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ICO Girona Hospital Josep Trueta, Girona
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Hospital Universitari Germans Trias i Pujol
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ICO Hospital Germans Trias i Pujol, Badalona (Barcelona)
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Hospital General Universitario de Elche
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Hospital General de Elche, Elche (Alicante), Spain
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Affiliation as printed
Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
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Affiliation as printed
Department of Hematology and Internal Diseases, State Hospital, Opole, Poland
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University of Milan · University of Wrocław · Wroclaw Medical University · Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico · Azienda Ospedaliera San Gerardo
Affiliation as printed
Department of Hematology, Blood neoplasms and Bone marrow transplantation, Wroclaw Medical University, Wroclaw, Poland
Hematology division and Bone marrow transplant unit, San Gerardo Hospital, ASST Monza, Monza
Hematology division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Università degli Studi di Milano, Milano, Italy
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Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Affiliation as printed
Hematology division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Azienda Ospedaliera San Gerardo
Affiliation as printed
Hematology division and Bone marrow transplant unit, San Gerardo Hospital, ASST Monza, Monza
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Affiliation as printed
Department of Molecular medicine, University of Pavia, Pavia
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Agostino Gemelli University Polyclinic · Istituti di Ricovero e Cura a Carattere Scientifico
Affiliation as printed
Fondazione Policlinico “A. Gemelli” IRCCS, Rome
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Guy's and St Thomas' NHS Foundation Trust
Affiliation as printed
Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
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Affiliation as printed
Hospital Clinic de Barcelona, Barcelona, Spain
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Affiliation as printed
Hospital Saint-Louis, Paris, France
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University of Milan · University of Wrocław · Wroclaw Medical University · Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico · Azienda Ospedaliera San Gerardo · Ospedale Papa Giovanni XXIII
Affiliation as printed
Department of Hematology, Blood neoplasms and Bone marrow transplantation, Wroclaw Medical University, Wroclaw, Poland
Hematology division and Bone marrow transplant unit, San Gerardo Hospital, ASST Monza, Monza
Hematology division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
ASST Papa Giovanni XXIII, Bergamo
Università degli Studi di Milano, Milano, Italy
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University of Florence · Azienda Ospedaliero-Universitaria Careggi
Affiliation as printed
Center Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Department of Experimental and Clinical Medicine, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence
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