1. Outcomes of Patients with COVID-19 from a Specialized Cancer Care Emergency Room
- Author
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Kelsey Maguire, Andriy Derkach, Nandini Umesh Yadav, Jeffrey S. Groeger, Petros Grivas, Ali Raza Khaki, Adam Klotz, Margaret M. Madeleine, Esther Babady, Lisa Tachiki, Sandy Simcha Nath, Afia Babar, Gary H. Lyman, Ying Taur, Justin Jee, Sanjay Chawla, Molly Maloy, Rocio Perez-Johnston, Daniel J. Henning, and H. Laura Aaltonen
- Subjects
Male ,Cancer Research ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Anemia ,Tachypnea ,Neoplasms ,Pandemic ,medicine ,Humans ,Aged ,Retrospective Studies ,business.industry ,SARS-CoV-2 ,Cancer ,COVID-19 ,General Medicine ,Emergency department ,medicine.disease ,Treatment Outcome ,Oncology ,Emergency medicine ,Cohort ,Female ,Biostatistics ,medicine.symptom ,business ,Emergency Service, Hospital - Abstract
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.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.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 ratio3, 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.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.
- Published
- 2021