Prognostic factors of mortality in patients with cancer infected with COVID-19: A systematic review and meta-analysis using the GRADE approach.

This study aimed to systematically synthesize the available evidence on prognostic factors affecting mortality in these patients. This review included cohort studies of adult patients with cancer diagnosed with Coronavirus disease 2019 (COVID-19). We searched MEDLINE and Embase for data from December 2019 to June 2025, and Cochrane Central Libraries and other databases for data to July 2023. Two independent reviewers screened references, extracted data, and assessed bias risk. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the certainty of the evidence and present the relative and absolute effect sizes. Fifty-two prognostic factors were identified from 92 included studies. These included sociodemographic variables, comorbidities, cancer-related characteristics, COVID-19-related clinical features, and laboratory results. We found high certainty associations between an increased risk of death and male sex (absolute risk [AR] = 3.7%, 95% confidence interval [CI] = 2.1% to 5.8%), high Charlson Comorbidity Index (AR = 8.8%, 95% CI = 7.2%-10.6%), low performance status (AR = 14.7%, 95% CI = 11.2%-18.7%), immunosuppression (AR = 14.5%, 95% CI = 7.3%-24.6%), kidney disease (AR = 9.2%, 95% CI = 4.9%-14.7%), and lung cancer (AR = 7.2%, 95% CI = 3.5%-12.0%). Hypoxia, high creatinine, high C-reactive protein, high D-dimer, low hemoglobin, low lymphocytes, high procalcitonin, and high white blood cell counts were also associated with increased mortality with high certainty. This comprehensive GRADE-based systematic review provides healthcare providers with evidence-based prognostic factors to predict outcomes, counsel patients, and guide treatment decisions for cancer patients with COVID-19. The findings offer crucial insights for managing this vulnerable population during the pandemic.