Mortalitatea la pacienţii cu hemopatii maligne diagnosticaţi cu COVID- 19

Abstract

Introducere. Tratamentul pacienţilor hematologici cu COVID-19 a devenit o adevărată încercare pentru sistemul medical, determinată de particularităţile evolutive. Scopul lucrării. Studiul este unicentric retrospectiv efectuat în cadrul Institutului Oncologic pentru a aprecia evoluţia şi mortalitatea la pacienţii oncologici hematologici confirmaţi cu Covid-19 internaţi în 2020-2021. Material şi metode. Datele anamnestice, clinice şi paraclinice (radiografia pulmonară, ultrasonografia abdomenului) au fost prelevate din fişe medicale. Diagnosticul stabilit histologic şi imunohistochimic conform clasificării Organizaţiei Mondiale a Sănătăţii din 2017. Infecţia COVID-19 confirmată prin test rapid sau PCR. Rezultate. În total au fost 144 de pacienţi oncologici cu COVID-19 confirmat prin test internaţi în 2020-2021, dintre care 22,9% (n = 33) cu hemopatii maligne: limfom - 39% (n = 13), mielom multiplu- 27% (9 persoane), leucemii acute- 16,5% (n = 5). La momentul confirmării COVID-19, 75% pacienţi au fost pe tratament de inducere şi 15% erau pacienţii internaţi primar pentru tratament specific. Evoluţie severă/ critică a COVID-19 s-a înregistrat în 75,9% (n = 23). Mortalitatea general era 33.9% (n = 10), determinate în 80% cazuri de dezvoltarea pneumoniei. Diferenţa semnificativă a mortalităţii a fost observată comparând 2020 şi 2021: 53% (9/17 cazuri) vs. 25% (3/16 cazuri). Concluzii. Evoluţia gravă a infecţiei Covid-19 este caracteristică pacienţilor hematologici, fiind înregistrate rate înalte de mortalitate.

Background. Therapeutic management in hematological patients during COVID-19 pandemic is a challenge for the medical staff, due to susceptibility and evolution. Objective of the study. This study is a single-center retrospective study from Oncological Institute of the Republic of Moldova aimed to evaluate outcomes and mortality for COVID-19 in 33 hematological patients in 2020-2021. Material and methods. Anamnestic, clinical, and paraclinical data (pulmonary radiography, ultrasonography of the abdomen) were taken from the medical record. Oncological diagnosis established histologically and immunochemically according to the WHO classification 2017. Results. Totally 144 of oncological patients with laboratory-confirmed Covid 19 were hospitalized, 22.9% (n = 33) of them were with hematological malignances. They were represented by Lymphoma 39% (n = 13 persons), multiple myeloma 27% (9 persons), acute leukemia 16.5% (n = 5). At the time of COVID-19 diagnosis, almost 75% of patients were on active treatment and 15% were primary diagnosed and have not received any specific treatment. Severe/critical COVID-19 was observed in 75.9% of patients (n = 23). The overall mortality rate was 33.9% (n = 10 patients). The primary cause of death was COVID-19 pneumonia in 80%. The mortality rate significantly decreased between 2020 and 2021 53% (9/17 cases) vs. 25% (3/16 cases). Conclusion. COVID-19 patients with hematological malignancies are at high risk of severe COVID-19 and lethal complications.