Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome

R. J. Lee, O. Wysocki, T. Bhogal, R. Shotton, A. Tivey, A Angelakas, T. Aung, K. Banfill, M. Baxter, H. Boyce, G. Brearton, E. Copson, E. Dickens, L. Eastlake, F. Gomes, C. Hague, M. Harrison, L. Horsley, P. Huddar, Z. HudsonS. Khan, U. T. Khan, A. Maynard, H. McKenzie, D. Palmer, T . Robinson, M. Rowe, A. Thomas, J. Tweedy, R. Sheehan, A. Stockdale, J. Weaver, S. Williams, C. Wilson, C. Zhou, C. Dive, T. Cooksley, C. Palmieri, A. Freitas, A. C. Armstrong

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Background: Cancer patients are at increased risk of death from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer and its treatment affect many haematological and biochemical parameters, therefore we analysed these prior to and during coronavirus disease 2019 (COVID-19) and correlated them with outcome.

Patients and methods: Consecutive patients with cancer testing positive for SARS-CoV-2 in centres throughout the United Kingdom were identified and entered into a database following local governance approval. Clinical and longitudinal laboratory data were extracted from patient records. Data were analysed using Mann-Whitney U test, Fisher's exact test, Wilcoxon signed rank test, logistic regression, or linear regression for outcomes. Hierarchical clustering of heatmaps was performed using Ward's method.

Results: In total, 302 patients were included in three cohorts: Manchester (n = 67), Liverpool (n = 62), and UK (n = 173). In the entire cohort (N = 302), median age was 69 (range 19-93 years), including 163 males and 139 females; of these, 216 were diagnosed with a solid tumour and 86 with a haematological cancer. Preinfection lymphopaenia, neutropaenia and lactate dehydrogenase (LDH) were not associated with oxygen requirement (O2) or death. Lymphocyte count (P < 0.001), platelet count (P = 0.03), LDH (P < 0.0001) and albumin (P < 0.0001) significantly changed from preinfection to during infection. High rather than low neutrophils at day 0 (P = 0.007), higher maximal neutrophils during COVID-19 (P = 0.026) and higher neutrophil-to-lymphocyte ratio (NLR; P = 0.01) were associated with death. In multivariable analysis, age (P = 0.002), haematological cancer (P = 0.034), C-reactive protein (P = 0.004), NLR (P = 0.036) and albumin (P = 0.02) at day 0 were significant predictors of death. In the Manchester/Liverpool cohort 30 patients have restarted therapy following COVID-19, with no additional complications requiring readmission.

Conclusion: Preinfection biochemical/haematological parameters were not associated with worse outcome in cancer patients. Restarting treatment following COVID-19 was not associated with additional complications. Neutropaenia due to cancer/treatment is not associated with COVID-19 mortality. Cancer therapy, particularly in patients with solid tumours, need not be delayed or omitted due to concerns that treatment itself increases COVID-19 severity.

Original languageEnglish
Article number100005
Number of pages12
JournalESMO open
Issue number1
Early online date27 Nov 2020
Publication statusPublished - Feb 2021


  • COVID-19
  • cancer
  • SARS-Cov-2
  • SARS-CoV-2

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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