Frontiers in Medicine (Jan 2021)

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

  • Pedro Kurtz,
  • Cassia Righy,
  • Monica Gadelha,
  • Fernando A. Bozza,
  • Fernando A. Bozza,
  • Patricia T. Bozza,
  • Bruno Gonçalves,
  • Leonardo S. L. Bastos,
  • Andre M. Vale,
  • Luiza M. Higa,
  • Leda Castilho,
  • Fabio L. Monteiro,
  • Nestor Charris,
  • Fernanda Fialho,
  • Ricardo Turon,
  • Alexandro Guterres,
  • Renan Lyra Miranda,
  • Carlos Henrique de Azeredo Lima,
  • Vanessa de Caro,
  • Marco Aurelio Prazeres,
  • Nina Ventura,
  • Clara Gaspari,
  • Fabio Miranda,
  • Paulo Jose da Mata,
  • Margarida Pêcego,
  • Sheila Mateos,
  • Maria Esther Lopes,
  • Shirley Castilho,
  • Álvaro Oliveira,
  • Carla Boquimpani,
  • Andréa Rabello,
  • Josiane Lopes,
  • Orlando Conceição Neto,
  • Orlando da C. Ferreira,
  • Amilcar Tanuri,
  • Paulo Niemeyer Filho,
  • Luiz Amorim

DOI
https://doi.org/10.3389/fmed.2021.630982
Journal volume & issue
Vol. 8

Abstract

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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).

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