PLoS ONE (Jan 2021)

Early but not late convalescent plasma is associated with better survival in moderate-to-severe COVID-19.

  • Neima Briggs,
  • Michael V Gormally,
  • Fangyong Li,
  • Sabrina L Browning,
  • Miriam M Treggiari,
  • Alyssa Morrison,
  • Maudry Laurent-Rolle,
  • Yanhong Deng,
  • Jeanne E Hendrickson,
  • Christopher A Tormey,
  • Mahalia S Desruisseaux

DOI
https://doi.org/10.1371/journal.pone.0254453
Journal volume & issue
Vol. 16, no. 7
p. e0254453

Abstract

Read online

BackgroundLimited 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 questionWhat are outcomes associated with administration of CCP in patients with moderate-to-severe COVID-19 infection?Study design and methodsWe 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.ResultsEarly 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.InterpretationEarly 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.