TY - JOUR T1 - Systemic pro-inflammatory response identifies patients with cancer with adverse outcomes from SARS-CoV-2 infection: the OnCovid Inflammatory Score JF - Journal for ImmunoTherapy of Cancer JO - J Immunother Cancer DO - 10.1136/jitc-2020-002277 VL - 9 IS - 3 SP - e002277 AU - Gino M Dettorre AU - Saoirse Dolly AU - Angela Loizidou AU - John Chester AU - Amanda Jackson AU - Uma Mukherjee AU - Alberto Zambelli AU - Juan Aguilar-Company AU - Mark Bower AU - Christopher C T Sng AU - Ramon Salazar AU - Alexia Bertuzzi AU - Joan Brunet AU - Ricard Mesia AU - Ailsa Sita-Lumsden AU - Elia Seguí AU - Federica Biello AU - Daniele Generali AU - Salvatore Grisanti AU - Pavetha Seeva AU - Gianpiero Rizzo AU - Michela Libertini AU - Antonio Maconi AU - Charlotte Moss AU - Beth Russell AU - Nadia Harbeck AU - Bruno Vincenzi AU - Rossella Bertulli AU - Diego Ottaviani AU - Raquel Liñan AU - Andrea Marrari AU - M Carmen Carmona-García AU - Neha Chopra AU - Carlo Alberto Tondini AU - Oriol Mirallas AU - Valeria Tovazzi AU - Vittoria Fotia AU - Claudia Andrea Cruz AU - Nadia Saoudi-Gonzalez AU - Eudald Felip AU - Ariadna Roqué AU - Alvin J X Lee AU - Tom Newsom-Davis AU - David García-Illescas AU - Roxana Reyes AU - Yien Ning Sophia Wong AU - Daniela Ferrante AU - Lorenza Scotti AU - Javier Marco-Hernández AU - Isabel Ruiz-Camps AU - Andrea Patriarca AU - Lorenza Rimassa AU - Lorenzo Chiudinelli AU - Michela Franchi AU - Armando Santoro AU - Aleix Prat AU - Alessandra Gennari AU - Mieke Van Hemelrijck AU - Josep Tabernero AU - Nikolaos Diamantis AU - David J Pinato A2 - , Y1 - 2021/03/01 UR - http://jitc.bmj.com/content/9/3/e002277.abstract N2 - Background Patients with cancer are particularly susceptible to SARS-CoV-2 infection. The systemic inflammatory response is a pathogenic mechanism shared by cancer progression and COVID-19. We investigated systemic inflammation as a driver of severity and mortality from COVID-19, evaluating the prognostic role of commonly used inflammatory indices in SARS-CoV-2-infected patients with cancer accrued to the OnCovid study.Methods In a multicenter cohort of SARS-CoV-2-infected patients with cancer in Europe, we evaluated dynamic changes in neutrophil:lymphocyte ratio (NLR); platelet:lymphocyte ratio (PLR); Prognostic Nutritional Index (PNI), renamed the OnCovid Inflammatory Score (OIS); modified Glasgow Prognostic Score (mGPS); and Prognostic Index (PI) in relation to oncological and COVID-19 infection features, testing their prognostic potential in independent training (n=529) and validation (n=542) sets.Results We evaluated 1071 eligible patients, of which 625 (58.3%) were men, and 420 were patients with malignancy in advanced stage (39.2%), most commonly genitourinary (n=216, 20.2%). 844 (78.8%) had ≥1 comorbidity and 754 (70.4%) had ≥1 COVID-19 complication. NLR, OIS, and mGPS worsened at COVID-19 diagnosis compared with pre-COVID-19 measurement (p<0.01), recovering in survivors to pre-COVID-19 levels. Patients in poorer risk categories for each index except the PLR exhibited higher mortality rates (p<0.001) and shorter median overall survival in the training and validation sets (p<0.01). Multivariable analyses revealed the OIS to be most independently predictive of survival (validation set HR 2.48, 95% CI 1.47 to 4.20, p=0.001; adjusted concordance index score 0.611).Conclusions Systemic inflammation is a validated prognostic domain in SARS-CoV-2-infected patients with cancer and can be used as a bedside predictor of adverse outcome. Lymphocytopenia and hypoalbuminemia as computed by the OIS are independently predictive of severe COVID-19, supporting their use for risk stratification. Reversal of the COVID-19-induced proinflammatory state is a putative therapeutic strategy in patients with cancer.Data are available upon reasonable request. ER -