Abstract
BACKGROUND: Patients with non-Hodgkin lymphoma (NHL) face heightened mortality and accelerated disease progression when persistently infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This critical situation underscores the urgent need to identify risk factors and establish early intervention strategies tailored to this vulnerable population. The primary aim of this study was to investigate the risk factors associated with persistent SARS-CoV-2 infection in NHL patients during the COVID-19 pandemic. METHODS: A retrospective cohort study was conducted using data from January 2020 to June 2024, obtained from the Aerospace Center Hospital's database, electronic health records, and laboratory archives. Inclusion criteria comprised patients with confirmed NHL and SARS-CoV-2 infection, with persistence defined as positive viral test results beyond 14 days after initial diagnosis. Patients with incomplete medical records or loss of follow-up were excluded. Predictive models were developed and refined using logistic regression and random forest algorithms. The models incorporated data on demographics, comorbidities, laboratory findings, and imaging results. Model performance was evaluated using accuracy, precision, and the area under the receiver operating characteristic curve (AUC-ROC). Validation was conducted on an independent dataset to ensure generalizability, and the best-performing model guided the development of a prediction tool for early risk assessment and intervention. RESULTS: Key risk factors for persistent SARS-CoV-2 infection in NHL patients included advanced age, hypertension, diabetes, immunosuppressed status, low lymphocyte count, elevated C-reactive protein, high body mass index, anemia, reduced CD4 + cell count, and the presence of lung lesions. The random forest model demonstrated superior predictive performance, achieving an AUC of 0.93. The study further highlighted that prompt antiviral therapy, adjustments to immunosuppressive regimens, and enhanced monitoring significantly reduced infection persistence. CONCLUSIONS: This study identifies critical risk factors for persistent SARS-CoV-2 infection in NHL patients and underscores the importance of early intervention strategies. These findings may guide clinical decision-making to improve outcomes in this high-risk population.