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Outcomes of Patients with COVID-19 from a Specialized Cancer Care Emergency Room
PURPOSE: Our goal was to identify discrete clinical characteristics associated with safe discharge from an emergency department/urgent care for patients with a history of cancer and concurrent COVID-19 infection during the SARS-CoV-2 pandemic and prior to widespread vaccination. PATIENTS AND METHODS...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9480619/ https://www.ncbi.nlm.nih.gov/pubmed/34709102 http://dx.doi.org/10.1080/07357907.2021.1985134 |
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author | Nath, Sandy Simcha Yadav, Nandini Umesh Derkach, Andriy Perez-Johnston, Rocio Tachiki, Lisa Maguire, Kelsey Babar, Afia Maloy, Molly A. Klotz, Adam Jee, Justin Taur, Ying Chawla, Sanjay Babady, Esther Khaki, Ali Raza Madeleine, Margaret M. Grivas, Petros Henning, Daniel J. Aaltonen, H. Laura Lyman, Gary H. Groeger, Jeffrey |
author_facet | Nath, Sandy Simcha Yadav, Nandini Umesh Derkach, Andriy Perez-Johnston, Rocio Tachiki, Lisa Maguire, Kelsey Babar, Afia Maloy, Molly A. Klotz, Adam Jee, Justin Taur, Ying Chawla, Sanjay Babady, Esther Khaki, Ali Raza Madeleine, Margaret M. Grivas, Petros Henning, Daniel J. Aaltonen, H. Laura Lyman, Gary H. Groeger, Jeffrey |
author_sort | Nath, Sandy Simcha |
collection | PubMed |
description | PURPOSE: Our goal was to identify discrete clinical characteristics associated with safe discharge from an emergency department/urgent care for patients with a history of cancer and concurrent COVID-19 infection during the SARS-CoV-2 pandemic and prior to widespread vaccination. PATIENTS AND METHODS: We retrospectively analyzed 255 adult patients with a history of cancer who presented to Memorial Sloan Kettering Cancer Center (MSKCC) urgent care center (UCC) from March 1, 2020 to May 31, 2020 with concurrent COVID-19 infection. We evaluated associations between patient characteristics and 30-day mortality from initial emergency department (ED) or urgent care center (UCC) visit and the absence of a severe event within 30 days. External validation was performed on a retrospective data from 29 patients followed at Fred Hutchinson Cancer Research Center that presented to the local emergency department. A late cohort of 108 additional patients at MSKCC from June 1, 2020 to January 31, 2021 was utilized for further validation. RESULTS: In the MSKCC cohort, 30-day mortality and severe event rate was 15% and 32% respectively. Using stepwise regression analysis, elevated BUN and glucose, anemia, and tachypnea were selected as the main predictors of 30-day mortality. Conversely, normal albumin, BUN, calcium, and glucose, neutrophil–lymphocyte ratio <3, lack of (severe) hypoxia, lack of bradycardia or tachypnea, and negative imaging were selected as the main predictors of an uneventful course as defined as a Lack Of a Severe Event within Thirty Days (LOSETD). Utilizing this information, we devised a tool to predict 30-day mortality and LOSETD which achieved an area under the operating curve (AUC) of 79% and 74% respectively. Similar estimates of AUC were obtained in an external validation cohort. A late cohort at MSKCC was consistent with the prior, albeit with a lower AUC CONCLUSION: We identified easily obtainable variables that predict 30-day mortality and the absence of a severe event for patients with a history of cancer and concurrent COVID-19. This has been translated into a bedside tool that the clinician may utilize to assist disposition of this group of patients from the emergency department or urgent care setting. |
format | Online Article Text |
id | pubmed-9480619 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
record_format | MEDLINE/PubMed |
spelling | pubmed-94806192022-09-16 Outcomes of Patients with COVID-19 from a Specialized Cancer Care Emergency Room Nath, Sandy Simcha Yadav, Nandini Umesh Derkach, Andriy Perez-Johnston, Rocio Tachiki, Lisa Maguire, Kelsey Babar, Afia Maloy, Molly A. Klotz, Adam Jee, Justin Taur, Ying Chawla, Sanjay Babady, Esther Khaki, Ali Raza Madeleine, Margaret M. Grivas, Petros Henning, Daniel J. Aaltonen, H. Laura Lyman, Gary H. Groeger, Jeffrey Cancer Invest Article PURPOSE: Our goal was to identify discrete clinical characteristics associated with safe discharge from an emergency department/urgent care for patients with a history of cancer and concurrent COVID-19 infection during the SARS-CoV-2 pandemic and prior to widespread vaccination. PATIENTS AND METHODS: We retrospectively analyzed 255 adult patients with a history of cancer who presented to Memorial Sloan Kettering Cancer Center (MSKCC) urgent care center (UCC) from March 1, 2020 to May 31, 2020 with concurrent COVID-19 infection. We evaluated associations between patient characteristics and 30-day mortality from initial emergency department (ED) or urgent care center (UCC) visit and the absence of a severe event within 30 days. External validation was performed on a retrospective data from 29 patients followed at Fred Hutchinson Cancer Research Center that presented to the local emergency department. A late cohort of 108 additional patients at MSKCC from June 1, 2020 to January 31, 2021 was utilized for further validation. RESULTS: In the MSKCC cohort, 30-day mortality and severe event rate was 15% and 32% respectively. Using stepwise regression analysis, elevated BUN and glucose, anemia, and tachypnea were selected as the main predictors of 30-day mortality. Conversely, normal albumin, BUN, calcium, and glucose, neutrophil–lymphocyte ratio <3, lack of (severe) hypoxia, lack of bradycardia or tachypnea, and negative imaging were selected as the main predictors of an uneventful course as defined as a Lack Of a Severe Event within Thirty Days (LOSETD). Utilizing this information, we devised a tool to predict 30-day mortality and LOSETD which achieved an area under the operating curve (AUC) of 79% and 74% respectively. Similar estimates of AUC were obtained in an external validation cohort. A late cohort at MSKCC was consistent with the prior, albeit with a lower AUC CONCLUSION: We identified easily obtainable variables that predict 30-day mortality and the absence of a severe event for patients with a history of cancer and concurrent COVID-19. This has been translated into a bedside tool that the clinician may utilize to assist disposition of this group of patients from the emergency department or urgent care setting. 2022-01 2021-10-28 /pmc/articles/PMC9480619/ /pubmed/34709102 http://dx.doi.org/10.1080/07357907.2021.1985134 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. |
spellingShingle | Article Nath, Sandy Simcha Yadav, Nandini Umesh Derkach, Andriy Perez-Johnston, Rocio Tachiki, Lisa Maguire, Kelsey Babar, Afia Maloy, Molly A. Klotz, Adam Jee, Justin Taur, Ying Chawla, Sanjay Babady, Esther Khaki, Ali Raza Madeleine, Margaret M. Grivas, Petros Henning, Daniel J. Aaltonen, H. Laura Lyman, Gary H. Groeger, Jeffrey Outcomes of Patients with COVID-19 from a Specialized Cancer Care Emergency Room |
title | Outcomes of Patients with COVID-19 from a Specialized Cancer Care Emergency Room |
title_full | Outcomes of Patients with COVID-19 from a Specialized Cancer Care Emergency Room |
title_fullStr | Outcomes of Patients with COVID-19 from a Specialized Cancer Care Emergency Room |
title_full_unstemmed | Outcomes of Patients with COVID-19 from a Specialized Cancer Care Emergency Room |
title_short | Outcomes of Patients with COVID-19 from a Specialized Cancer Care Emergency Room |
title_sort | outcomes of patients with covid-19 from a specialized cancer care emergency room |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9480619/ https://www.ncbi.nlm.nih.gov/pubmed/34709102 http://dx.doi.org/10.1080/07357907.2021.1985134 |
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