Top COVID-19 Prognostic Factors Identified

Researchers have identified more than a dozen factors that may increase COVID-19's severity. But for patients with thoracic malignancies, seven variables predict the likelihood of dying, according to a recent study that analyzed data from the international TERAVOLT registry (J Thorac Oncol 2022 Feb 1 [Epub ahead of print]). The study also demonstrates that creating real-time databases like TERAVOLT is feasible—and that they capture valuable information.

The registry, which was launched in March 2020 and now houses data from 92 centers in 19 countries, was designed to track the effect of COVID-19 on patients with thoracic malignancies. Clinicians entered patients’ demographics, comorbidities, cancer treatments, and cancer lab test results. In a preliminary analysis of the first 200 patients, researchers reported a mortality rate of 33% and identified several variables that correlated with the risk of death, including age, smoking status, and comorbidities (Lancet Oncol 2020;21:914–22).

The goal of the recent study was to help clinicians determine which patients might need greater monitoring or changes in care, says coauthor Jennifer Whisenant, PhD, of Vanderbilt University Medical Center in Nashville, TN. She and her colleagues analyzed data from 1,491 patients in the TERAVOLT registry hospitalized between March 2020 and April 2021. They assessed whether any of 73 variables—such as body mass index, smoking status, age, gender, and the number and type of cancer therapies received—correlated with mortality risk during an average follow-up of 42 days. Given this short period, deaths likely resulted from COVID-19, not cancer.

At 24.2%, the overall mortality rate was lower than in the initial study. Eastern Cooperative Oncology Group (ECOG) performance status had the greatest influence on the risk of death, followed by neutrophil count, which other studies have linked to the immune overreaction that appears to kill some patients with COVID-19. The rest of the seven mortality risk factors were serum procalcitonin levels, development of pneumonia, C-reactive protein levels, tumor stage, and age.

The researchers provide a predictive nomogram that accounts for each of the seven factors.

Notably, the cutoff date for the study was April 15, 2021, before many patients were vaccinated. However, Whisenant and coauthor Alessio Cortellini, MD, of Imperial College London, UK, say that the results remain relevant because of the prevalence of vaccine hesitancy and because patients with thoracic malignancies may have weak responses to SARS-CoV-2 vaccination. They add that the TERAVOLT researchers are planning studies to examine the severity of the SARS-CoV-2 omicron strain on mortality, the effect of hospital crowding, and other factors.

“The study is addressing an important issue,” says Robert Cerfolio, MD, of NYU Langone Health in New York, who wasn't connected to the research. The message, he says, is that most patients with cancer can continue their treatment.

Daniel Boffa, MD, of Yale School of Medicine in New Haven, CT, who wasn't connected to the research either, says so much has changed since the study's cutoff date—including the increased availability of vaccination, development of new viral variants, and approval of additional COVID therapies—that the findings probably won't alter treatment for most patients. However, he says, TERAVOLT is significant because it shows “a first-in-history level of connectivity among the global cancer community.” TERAVOLT's rapid collection and sharing of data makes an analysis like the one the authors performed “possible in an almost real-time manner.”

Similar databases could help researchers improve cancer treatment and allow rapid responses to future pandemics, Boffa argues. “Judging the importance of TERAVOLT on the impact of a single study is short sighted. It would be akin to asking the Wright brothers after their first flight, ‘Who would ever need to fly 120 feet?’” –Mitch Leslie

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