tetano
Editor, Senior Moderator
PLoS One
. 2021 Jul 28;16(7):e0254453.
doi: 10.1371/journal.pone.0254453. eCollection 2021.
Early but not late convalescent plasma is associated with better survival in moderate-to-severe COVID-19
Neima Briggs[SUP] 1 [/SUP], Michael V Gormally[SUP] 1 [/SUP], Fangyong Li[SUP] 2 [/SUP], Sabrina L Browning[SUP] 3 [/SUP], Miriam M Treggiari[SUP] 4 [/SUP], Alyssa Morrison[SUP] 5 [/SUP], Maudry Laurent-Rolle[SUP] 6 [/SUP], Yanhong Deng[SUP] 2 [/SUP], Jeanne E Hendrickson[SUP] 7 8 [/SUP], Christopher A Tormey[SUP] 7 [/SUP], Mahalia S Desruisseaux[SUP] 6 [/SUP]
Affiliations
Abstract
Background: Limited therapeutic options exist for coronavirus disease 2019 (COVID-19). COVID-19 convalescent plasma (CCP) is a potential therapeutic, but there is limited data for patients with moderate-to-severe disease.
Research question: What are outcomes associated with administration of CCP in patients with moderate-to-severe COVID-19 infection?
Study design and methods: We conducted a propensity score-matched analysis of patients with moderate-to-severe COVID-19. The primary endpoints were in-hospital mortality. Secondary endpoints were number of days alive and ventilator-free at 30 days; length of hospital stay; and change in WHO scores from CCP administration (or index date) to discharge. Of 151 patients who received CCP, 132 had complete follow-up data. Patients were transfused after a median of 6 hospital days; thus, we investigated the effect of convalescent plasma before and after this timepoint with 77 early (within 6 days) and 55 late (after 6 days) recipients. Among 3,217 inpatients who did not receive CCP, 2,551 were available for matching.
Results: Early CCP recipients, of whom 31 (40%) were on mechanical ventilation, had lower 14-day (15% vs 23%) and 30-day (38% vs 49%) mortality compared to a matched unexposed cohort, with nearly 50% lower likelihood of in-hospital mortality (HR 0.52, [95% CI 0.28-0.96]; P = 0.036). Early plasma recipients had more days alive and ventilator-free at 30 days (+3.3 days, [95% CI 0.2 to 6.3 days]; P = 0.04) and improved WHO scores at 7 days (-0.8, [95% CI: -1.2 to -0.4]; P = 0.0003) and hospital discharge (-0.9, [95% CI: -1.5 to -0.3]; P = 0.004) compared to the matched unexposed cohort. No clinical differences were observed in late plasma recipients.
Interpretation: Early administration of CCP improves outcomes in patients with moderate-to-severe COVID-19, while improvement was not observed with late CCP administration. The importance of timing of administration should be addressed in specifically designed trials.
. 2021 Jul 28;16(7):e0254453.
doi: 10.1371/journal.pone.0254453. eCollection 2021.
Early but not late convalescent plasma is associated with better survival in moderate-to-severe COVID-19
Neima Briggs[SUP] 1 [/SUP], Michael V Gormally[SUP] 1 [/SUP], Fangyong Li[SUP] 2 [/SUP], Sabrina L Browning[SUP] 3 [/SUP], Miriam M Treggiari[SUP] 4 [/SUP], Alyssa Morrison[SUP] 5 [/SUP], Maudry Laurent-Rolle[SUP] 6 [/SUP], Yanhong Deng[SUP] 2 [/SUP], Jeanne E Hendrickson[SUP] 7 8 [/SUP], Christopher A Tormey[SUP] 7 [/SUP], Mahalia S Desruisseaux[SUP] 6 [/SUP]
Affiliations
- PMID: 34320004
- DOI: 10.1371/journal.pone.0254453
Abstract
Background: Limited therapeutic options exist for coronavirus disease 2019 (COVID-19). COVID-19 convalescent plasma (CCP) is a potential therapeutic, but there is limited data for patients with moderate-to-severe disease.
Research question: What are outcomes associated with administration of CCP in patients with moderate-to-severe COVID-19 infection?
Study design and methods: We conducted a propensity score-matched analysis of patients with moderate-to-severe COVID-19. The primary endpoints were in-hospital mortality. Secondary endpoints were number of days alive and ventilator-free at 30 days; length of hospital stay; and change in WHO scores from CCP administration (or index date) to discharge. Of 151 patients who received CCP, 132 had complete follow-up data. Patients were transfused after a median of 6 hospital days; thus, we investigated the effect of convalescent plasma before and after this timepoint with 77 early (within 6 days) and 55 late (after 6 days) recipients. Among 3,217 inpatients who did not receive CCP, 2,551 were available for matching.
Results: Early CCP recipients, of whom 31 (40%) were on mechanical ventilation, had lower 14-day (15% vs 23%) and 30-day (38% vs 49%) mortality compared to a matched unexposed cohort, with nearly 50% lower likelihood of in-hospital mortality (HR 0.52, [95% CI 0.28-0.96]; P = 0.036). Early plasma recipients had more days alive and ventilator-free at 30 days (+3.3 days, [95% CI 0.2 to 6.3 days]; P = 0.04) and improved WHO scores at 7 days (-0.8, [95% CI: -1.2 to -0.4]; P = 0.0003) and hospital discharge (-0.9, [95% CI: -1.5 to -0.3]; P = 0.004) compared to the matched unexposed cohort. No clinical differences were observed in late plasma recipients.
Interpretation: Early administration of CCP improves outcomes in patients with moderate-to-severe COVID-19, while improvement was not observed with late CCP administration. The importance of timing of administration should be addressed in specifically designed trials.