By Denise Baez
High admission severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load predicts mortality in hospitalised patients with and without cancer, according to a study published in Cancer Cell.
Lars F. Westblade, MD, Weill Cornell Medicine, New York, New York, and colleagues looked at cycle threshold (Ct) values from reverse transcription-polymerase chain reaction (PCR) assays of 100 patients with cancer and 2,914 patients without cancer who were admitted to 3 hospitals in New York City between March 15 and May 14, 2020.
Overall, the in-hospital mortality rate was 38.8% among patients with a high viral load, 24.1% among patients with a medium viral load, and 15.3% among patients with a low viral load (P< .001).
Among patients with cancer, those with a high viral load had a mortality rate of 45.2%, those with a medium viral load had a mortality rate of 28%, and those with a low viral load had a mortality rate of 12.1%; P = .008).
The study also showed that patients with haematologic malignancies had higher median viral loads (Ct = 25.0) than patients without cancer (Ct = 29.2; P = .0039). The presence of a haematological malignancy was independently associated with having a high viral load upon admission compared with patients without cancer, even after adjusting for potential confounders (adjusted odds ratio [aOR] = 2.52; 95% confidence interval [CI], 1.30-4.88; P = .006). In contrast, having a solid tumour was not associated with having a high viral load in univariate or multivariate analyses compared with patients without cancer.
In a multivariate logistic regression model among patients with active cancer that adjusted for age and need for supplemental oxygen within 3 hours of presentation to the emergency department, the researchers found that having a high viral load was independently associated with increased in-hospital mortality (aOR = 5.00; 95% CI, 1.42-8.85; P = .012) compared with having a low viral load.
“We found that admission viral load was not only associated with mortality using the cobas assay, but was also associated with mortality using the commonly-used Xpert Xpress assay,” the authors noted. “We believe reporting Ct values from these assays in patients with and without cancer would provide valuable information that could be used by clinicians to identify patients at high risk of clinical decompensation who may benefit from more intensive monitoring. This information could also be used when allocating scarce resources.”
The median age of the entire cohort was 65 years, 43.6% of patients were female, and 78.1% were non-White. Laboratory parameters were generally similar between groups, but patients with cancer were less likely to have elevated aspartate aminotransferase levels and more likely to have elevated procalcitonin levels than patients without cancer.
In addition to having a haematologic malignancy, other variables that were independently associated with having a high viral load upon admission included increased age; congestive heart failure; diabetes; chronic kidney disease; home use of inhaled, nasal, or oral steroids; residence in a nursing home or rehabilitation facility; and presentation from March 15 to 29, 2020 — before the peak of new infections began in New York.