Effect of Convalescent Plasma in Critically Ill Patients With COVID-19: An Observational Study

Frontiers in Medicine

article

Pedro Kurtz¹  Leda Castilho²  Fabio L. Monteiro³  Nestor Charris¹  Fernanda Fialho¹  Ricardo Turon¹  Alexandro Guterres¹  Renan Lyra Miranda¹  Carlos Henrique de Azeredo Lima¹  Vanessa de Caro¹  Marco Aurelio Prazeres¹  Cassia Righy¹  Nina Ventura¹  Clara Gaspari¹  Fabio Miranda¹  Paulo Jose da Mata¹  Margarida Pêcego⁴  Sheila Mateos⁴  Maria Esther Lopes⁴  Shirley Castilho⁴  Álvaro Oliveira⁴  Carla Boquimpani⁴  Monica Gadelha¹  Andréa Rabello⁴  Josiane Lopes⁴  Orlando Conceição Neto⁴  Orlando da C. Ferreira, Jr.³  Amilcar Tanuri³  Paulo Niemeyer Filho¹  Luiz Amorim⁴  Fernando A. Bozza⁵  Patricia T. Bozza⁷  Bruno Gonçalves¹  Leonardo S. L. Bastos⁸  Andre M. Vale⁹  Luiza M. Higa³ 

[1] Instituto Estadual do Cérebro Paulo Niemeyer;Laboratory of Cell Culture Engineering, Chemical Engineering Program, Federal University of Rio de Janeiro (UFRJ);Laboratory of Molecular Virology, Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro;Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti (HEMORIO);D'Or Institute for Research and Education;National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation;Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation;Industrial Engineering Department, Pontifical Catholic University of Rio de Janeiro (PUC-Rio);Laboratory of Lymphocyte Biology, Program in Immunobiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro (UFRJ)

关键词: convalescent plasma;    coronavirus;    acute respiratory distress syndrome;    COVID-19;    survival;   

DOI  :  10.3389/fmed.2021.630982

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Convalescent plasma is a potential therapeutic option for critically ill patients with coronavirus disease 19 (COVID-19), yet its efficacy remains to be determined. The aim was to investigate the effects of convalescent plasma (CP) in critically ill patients with COVID-19. Methods: This was a single-center prospective observational study conducted in Rio de Janeiro, Brazil, from March 17th to May 30th, with final follow-up on June 30th. We included 113 laboratory-confirmed COVID-19 patients with respiratory failure. Primary outcomes were time to clinical improvement and survival within 28 days. Secondary outcomes included behavior of biomarkers and viral loads. Kaplan–Meier analyses and Cox proportional-hazards regression using propensity score with inverse-probability weighing were performed. Results: 41 patients received CP and 72 received standard of care (SOC). Median age was 61 years (IQR 48–68), disease duration was 10 days (IQR 6–13), and 86% were mechanically ventilated. At least 29 out of 41CP-recipients had baseline IgG titers ≥ 1:1,080. Clinical improvement within 28 days occurred in 19 (46%) CP-treated patients, as compared to 23 (32%) in the SOC group [adjusted hazard ratio (aHR) 0.91 (0.49–1.69)]. There was no significant change in 28-day mortality (CP 49% vs. SOC 56%; aHR 0.90 [0.52–1.57]). Biomarker assessment revealed reduced inflammatory activity and increased lymphocyte count after CP. Conclusions: In this study, CP was not associated with clinical improvement or increase in 28-day survival. However, our study may have been underpowered and included patients with high IgG titers and life-threatening disease. Clinical Trial Registration: The study protocol was retrospectively registered at the Brazilian Registry of Clinical Trials (ReBEC) with the identification RBR-4vm3yy ( http://www.ensaiosclinicos.gov.br ).

【 授权许可】

CC BY