The Efficiency of Convalescent Plasma Therapy in the Management of Critically Ill Patients Infected With COVID-19: A Matched Cohort Study

Chun Pan, Hui Chen, Jianfeng Xie, Yingzi Huang, Yi Yang, Bin Du, Haibo Qiu, Chun Pan, Hui Chen, Jianfeng Xie, Yingzi Huang, Yi Yang, Bin Du, Haibo Qiu

Abstract

Background: The convalescent plasma of patients who recover from coronavirus disease 2019 (COVID-19) contains high titers of neutralizing antibodies, which has potential effects on the viral shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and improving the prognosis of patients with COVID-19. The goal of this study was to clarify the effects of convalescent plasma therapy on the 60-day mortality and negative conversion rate of SARS-CoV-2 during the hospitalization of patients with severe and life-threatening COVID-19 infection.

Methods: This was a retrospective, case-matched cohort study that involved patients with severe COVID-19 infections. The patients who received convalescent plasma therapy were matched by age, sex, diabetes, hypertension, heart failure, the onset of symptoms to hospital admission, respiratory support pattern, lymphocyte count, troponin, Sequential organ failure assessment (SOFA), glucocorticoid, and antiviral agents to no more than three patients with COVID-19 who did not receive convalescent plasma therapy. A Cox regression model and competing risk analysis were used to evaluate the effects of convalescent plasma therapy on these patients.

Results: Twenty-six patients were in the convalescent plasma therapy group, and 78 patients were in the control group. Demographic characteristics were similar in both groups, except for the SOFA score. Convalescent plasma therapy did not improve 60-day mortality [hazard ratio (HR) 1.44, 95% CI 0.82-2.51, p = 0.20], but the SARS-CoV-2 negative conversion rate for 60 days after admission was higher in the convalescent plasma group (26.9 vs. 65.4%, p = 0.002) than in the control. Then, a competing risk analysis was performed, which considered events of interest (the negative conversion rate of SARS-CoV-2) and competing events (death) in the same model. Convalescent plasma therapy improved events of interest (p = 0.0002).

Conclusion: Convalescent plasma therapy could improve the SARS-CoV-2 negative conversion rate but could not improve 60-day mortality in patients with severe and life-threatening COVID-19 infection.

Clinical trial number: The study was registered at ClinicalTrials.gov (NCT04616976).

Keywords: COVID-19; convalescent plasma therapy; mechanical ventilation; mortality; viral shedding.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Pan, Chen, Xie, Huang, Yang, Du and Qiu.

Figures

Figure 1
Figure 1
Flow diagram.
Figure 2
Figure 2
Effects of convalescent plasma therapy on 60-day mortality according to subgroups in severe and life-threatening coronavirus disease 2019 (COVID-19). SOFA score, sequential organ failure assessment scores; IMV, invasive mechanical ventilation; CP, convalescent plasma therapy.
Figure 3
Figure 3
Competing risk analysis to explore Convalescent plasma therapy associated with events of interest in severe and life-threatening coronavirus disease 2019 (COVID-19). No CP SARS-CoV-2 negative vs. CP SARS-CoV-2 negative, p = 0.002; No CP death vs. CP death, p = 0.02. CP, convalescent plasma therapy.

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