Predictive factors of delayed viral clearance of asymptomatic omicron-related COVID-19 screened positive in cancer patients receiving active anti-cancer treatment.

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Abstract

We sought to identify predictors of delayed viral clearance in cancer patients with asymptomatic COVID-19 when the SARS-CoV-2 omicron variants prevailed in Hong Kong.All cancer patients attending radiation therapy for head and neck malignancies or systemic anti-cancer therapy saved their deep-throat saliva or nasopharyngeal swabs at least twice weekly for SARS-CoV-2 between January 1 and April 30, 2022. Multivariate analyses identified predictors of delayed viral clearance (or slow recovery), defined as >21 days for the Ct values rising to ≥30 or undetectable in 2 consecutive samples saved within 72 hours. Three machine learning (ML) algorithms evaluated the prediction performance of the predictors.Two hundred (15%) out of 1,309 patients tested positive for SARS-CoV-2. Age >65 years (P-value = 0.036), male (P-value = 0.003), high Charlson comorbidity index (P-value = 0.042), lung cancer (P-value = 0.018), immune checkpoint inhibitor (P-value = 0.036), and receipt of ≤1 dose of COVID-19 vaccine (P-value = 0.003) were significant predictors. The three ML algorithms revealed that the mean ± standard deviation area-under-the-curve values predicting delayed viral clearance with the cut-off Ct value ≥30 was 0.72 ± 0.11.We identified subgroups with delayed viral clearance that may benefit from targeted interventions.Copyright © 2023. Published by Elsevier Ltd.