Outcomes of patients with COVID-19 from a specialized cancer care emergency room Journal Article
| Authors: | Nath, S. S.; Yadav, N. U.; Derkach, A.; Perez-Johnston, R.; Tachiki, L.; Maguire, K.; Babar, A.; Maloy, M. A.; Klotz, A.; Jee, J.; Taur, Y.; Chawla, S.; Babady, E.; Khaki, A. R.; Madeleine, M. M.; Grivas, P.; Henning, D. J.; Aaltonen, H. L.; Lyman, G. H.; Groeger, J. |
| Article Title: | Outcomes of patients with COVID-19 from a specialized cancer care emergency room |
| Abstract: | 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. © 2021 The Author(s). Published with license by Taylor and Francis Group, LLC. |
| Keywords: | biostatistics; covid-19; decision analysis outcomes; medical utilization |
| Journal Title: | Cancer Investigation |
| Volume: | 40 |
| Issue: | 1 |
| ISSN: | 0735-7907 |
| Publisher: | Informa Healthcare |
| Date Published: | 2022-01-01 |
| Start Page: | 17 |
| End Page: | 25 |
| Language: | English |
| DOI: | 10.1080/07357907.2021.1985134 |
| PUBMED: | 34709102 |
| PROVIDER: | scopus |
| PMCID: | PMC9480619 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 February 2022 -- Source: Scopus |
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