Abstract 1689P
Background
Over the last two months we have frequently been contacted to estimate the prognosis of cancer patients (pts) affected by COVID-19 infection. Until now, there have been no clear markers to guide decision making regarding the appropriateness of invasive ventilation (IV) in COVID-19 cancer pts. Therefore, we developed a practical tool which encompasses a prognostic score in order to identify a subgroup of pts likely to have a better outcome and therefore may be potential candidates for IV.
Methods
The Milano Policlinico ONCOVID-ICU score includes three different groups of variables. In the first group we included sex, age, body mass index (BMI) and comorbidities. The second group includes oncological variables, such as the treatment intent (adjuvant or metastatic), life expectancy in months and treatment status (on/off). Furthermore, we included the SOFA score [1] and the d-dimer values, previously reported as risk factors for mortality in the presence of COVID-19 infection.
Results
We identified three different groups. We recommend that pts with a low risk score should be offered IV if necessary, while high-risk pts are best managed with best supportive care. Pts in the intermediate-risk group deserve a case-by-case discussion to derive a decision (Table). Table: 1689P
The Milano Policlinico ONCOVID-ICU score
| Variables | Score | Categories of risk for pts |
| Linked to pts | Score < 4: Low Risk ICU admission and IV. Score 4 - 6: Intermediate Risk Case-by-case evaluation for ICU admission and IV. Score >= 7: High Risk Palliative care. | |
| Sex | F = 0 M = 1 | |
| Age | < 70 = 0 >= 70 = 1 | |
| BMI | < 30 = 0 >= 30 = 1 | |
| Comorbidities | NO = 0 YES = 1 YES > 1 = 2 | |
| Oncological | ||
| Treatment intent | Curative = 0 Palliative = 1 | SOFA SCORE [1] - PaO2/FIO2 (P/F) - Platelets - Bilirubin - Hypotension - Glasgow Coma Score Scale - Creatinine - Ventilatory support |
| Life expectancy | < 6 mo = 0 > 6 mo = 1 | |
| Pts on treatment | NO = 0 YES = 1 | |
| Clinical + lab values | ||
| SOFA score | 2-7 = 0 >= 8 = 1 | |
| D-dimer | < 1 μg/mL = 0 > 1 μg/mL = 1 |
Legend: BMI: body-mass index; F: female; FIO 2 : fraction of inspired oxigen; IV: invasive ventilation; M: male; mo: months; PaO 2 : partial pressure of oxigen; Pts: patients.
Conclusions
A considerable proportion of oncology pts may experience clinical deterioration due to the worsening course of the infection. These cases require a comprehensive evaluation before considering ICU admission and IV. The division between groups is arbitrary and the score needs further validation. Therefore, we plan to assess the clinical history of all cancer pts admitted to Milano Hospital Maggiore Policlinico’s ICU and retrospectively apply the score to this cohort. [1] Ferreira FL et al. JAMA 2001; 286:1754-8.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Financed by Italian fiscal contribution \"5x1000\" 2016 devolved to Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico.
Disclosure
All authors have declared no conflicts of interest.