Prognostic value of pro-inflammatory neutrophils and C-reactive protein in cancer patient with COVID-19: a multi-center, retrospective study

protein can be used as an independent influencing factor for adverse clinical outcome. 49 Moreover, the dynamic changes of neutrophils and C-reactive protein were also 50 presented, and compared with COVID-19 patients without cancer, cancer patients 51 with COVID-19 showed higher neutrophil counts and C-reactive protein levels. 52 Conclusions : In cancer patients with COVID-19, the significant increase in pro- 53 inflammatory neutrophil and C-reactive protein indicated a more critical illness and 54 adverse clinical outcome, and pro-inflammatory neutrophils and C-reactive protein 55 played a more adverse effect compare with COVID-19 patients without cancer, which 56 may be the cause of critical illness and adverse clinical outcomes of cancer patients 57 with COVID-19. 58


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when the data were normally distributed; otherwise, the Mann-Whitney test was 127 used. In addition, in multivariate analysis, binary logistic regression analysis is used 128 for binary classification variables such as survival status; ordinal logistic regression 129 analysis is used for ordered classification variables such as disease severity. All 130 statistical analyses were performed with the SPSS (version 23.0) software. 131 Results 132

Presenting demographic, Clinical Characteristics and Outcome 133
A total of 112 cancers infected with COVID-19 (Supplementary Table 1

Independent factors for the adverse clinical outcome of COVID-19 166
Meanwhile, we analyzed the correlation between inflammatory factors in laboratory 167 parameters and the adverse clinical outcomes of COVID-19. Univariate analysis 168 showed that erythrocyte count, hemoglobin count, neutrophil count, LDH, 169 procalcitonin, CRP, and IL-6 may be factors that affect the adverse clinical outcome 170 of COVID-19 (Table 3). Compared to surviving patients, non-surviving patients also 171 showed lower erythrocyte count and hemoglobin count, higher neutrophil counts, and 172 higher levels of LDH, procalcitonin, CRP, and IL-6. Multivariate analysis showed 173 that neutrophil counts (OR, 1.286; 95% CI, 1.007-1.536; P = 0.005) and CRP (OR, 174 12 1.047; 95% CI, 1.016-1.079; P = 0.003) levels were found to be independent 175 predictors of adverse clinical outcomes of COVID-19 (Table 4). Higher neutrophil 176 counts and higher levels of CRP were predictive of adverse clinical outcomes. 177

Dynamic changes of pro-inflammatory neutrophils and CRP 178
The above results indicated that the pro-inflammatory neutrophils and CRP are 179 independent predictors of COVID-19 severity and clinical adverse outcomes.   Table 3). 207

Discussion 208
In this study, we retrospectively analyzed the laboratory data and clinical outcomes of  First, this was a retrospective study, and the number of study cases is somewhat small. 261 There were also deficiencies in the number of medical records in the control group. 262 Second, we did not consider enough risk factors to establish a risk assessment model 263 and have not fully considered the unmeasured confounding factors. In the end, the 264 mechanism by which pro-inflammatory neutrophils and CRP aggravate the disease of 265 COVID-19 and cause poor prognosis remains to be further investigated.

This study was reviewed and approved by Ethics Committee of the Tongji Medical 285
College of Huazhong University of Science and Technology (No.TJ-2020S098). The 286 exemption from informed patients' consent was approved by the ethics committee 287 because of the rapid spread of the infection and the rapid progression of some cases. 288

Consent for publication 289
Not applicable. 290

Availability of data and materials 291
Not applicable. 292

Competing interests 293
The authors declare that they have no competing interests.  397 Figure 1. Dynamic changes of inflammation-related indicators. 398