Two inflammatory markers are associated with an increased risk of post-COVID-19 sequelae in patients with solid tumors, according to an analysis of the OnCovid registry published in the Journal of the National Cancer Institute.

Researchers found that elevated C-reactive protein (CRP) levels and neutrophil-to-lymphocyte ratios (NLR) are associated with an increased risk of post-COVID-19 sequelae — also known as long COVID. 

Long COVID is estimated to occur in 13% to 60% of COVID-19 survivors in the general population, the researchers noted. A previous analysis of data from the OnCovid registry suggested that 15% of COVID-19 survivors with cancer have long COVID.

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To investigate whether a pro-inflammatory status is associated with long COVID in patients with cancer, researchers analyzed 1339 patients enrolled in the European OnCovid registry ( identifier: NCT04393974). The patients had a history of solid tumors and were diagnosed with COVID-19 between February 2020 and February 2021. 

All patients were clinically reassessed during a routine oncologic follow-up visit a median of 44 days after their COVID-19 diagnosis. 

Overall, 203 patients (15.2%) developed post-COVID-19 sequelae. The most common protracted symptoms were respiratory, affecting 47.8% of patients (97/203), followed by fatigue in 43.8% (n=89), weight loss in 6.4% (n=13), neurocognitive symptoms in 6.9% (n=14), and other symptoms in 23.1% (n=47).

Compared with counterparts who did not develop post-COVID-19 sequelae, the patients who developed sequelae had a higher median CRP level (77.5 mg/L vs 22.2 mg/L; P <.001), a higher median NLR (6.0 vs 4.3; P =.001), and a higher median lactate dehydrogenase level (310 UI/L vs 274 UI/L; P =.028) at baseline. 

A multivariate analysis showed that elevated CRP level was significantly associated with overall post-COVID-19 sequelae (odds ratio [OR], 2.56; 95% CI, 1.67-3.91) and respiratory sequelae (OR, 3.03; 95% CI, 1.71-5.36). An elevated NLR was also significantly associated with overall sequelae (OR, 1.45; 95% CI, 1.01-2.10) and respiratory sequelae (OR, 2.01; 95% CI, 1.21-3.31). 

Other factors associated with an increased risk of post-COVID-19 sequelae included receipt of COVID-19 therapy (OR, 1.46; 95% CI, 1.02-2.08), COVID-19-associated complications (OR, 3.69; 95% CI, 2.54-5.34), and hospitalization due to COVID-19 (OR, 2.77; 95% CI, 1.65-4.64).

Compared with peers receiving no systemic anticancer therapy, patients receiving chemotherapy had a decreased risk of developing post-COVID-19 sequelae (OR, 0.57; 95% CI, 0.36-0.91). In contrast, treatment with immune checkpoint inhibitors, endocrine therapy, or targeted therapies — tyrosine kinase inhibitors, monoclonal antibodies, PARP inhibitors, or CDK inhibitors — was not significantly associated with post-COVID-19 sequelae.

The researchers concluded that this study “provides clinically useful information regarding the diagnostic ability of routinely available inflammatory markers/indices to individuate patients at higher risk of developing COVID-19 sequelae.” 

The researchers added that these patients “should be prioritize[d] for tailored follow-up procedures, proactive rehabilitation, and clinical trials with anti-inflammatory and/or immune-modulating strategies.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Cortellini A, Gennari A, Pommeret F, et al. COVID-19 sequelae and the host pro-inflammatory response: An analysis from the OnCovid Registry. J Natl Cancer Inst. 2022;djac057. doi:10.1093/jnci/djac057