Mayo Clinic Proceedings: Innovations, Quality & Outcomes (Oct 2023)
Rates Among Hospitalized Patients With COVID-19 Treated With Convalescent Plasma: A Systematic Review and Meta-Analysis
- Jonathon W. Senefeld, PhD,
- Ellen K. Gorman, BS,
- Patrick W. Johnson, BS,
- M. Erin Moir, PhD,
- Stephen A. Klassen, PhD,
- Rickey E. Carter, PhD,
- Nigel S. Paneth, MD,
- David J. Sullivan, MD,
- Olaf H. Morkeberg, BA,
- R. Scott Wright, MD,
- DeLisa Fairweather, PhD,
- Katelyn A. Bruno, PhD,
- Shmuel Shoham, MD,
- Evan M. Bloch, MBChB, MS,
- Daniele Focosi, MD,
- Jeffrey P. Henderson, MD, PhD,
- Justin E. Juskewitch, MD, PhD,
- Liise-Anne Pirofski, MD,
- Brenda J. Grossman, MD, MPH,
- Aaron A.R. Tobian, MD, PhD,
- Massimo Franchini, MD,
- Ravindra Ganesh, MBBS, MD,
- Ryan T. Hurt, MD, PhD,
- Neil E. Kay, MD,
- Sameer A. Parikh, MBBS,
- Sarah E. Baker, PhD,
- Zachary A. Buchholtz, BS,
- Matthew R. Buras, BS,
- Andrew J. Clayburn, BS,
- Joshua J. Dennis, BS,
- Juan C. Diaz Soto, MD,
- Vitaly Herasevich, MD, PhD,
- Allan M. Klompas, MB, BCh, BAO,
- Katie L. Kunze, PhD,
- Kathryn F. Larson, MD,
- John R. Mills, PhD,
- Riley J. Regimbal, BS,
- Juan G. Ripoll, MD,
- Matthew A. Sexton, MD,
- John R.A. Shepherd, MD,
- James R. Stubbs, MD,
- Elitza S. Theel, PhD,
- Camille M. van Buskirk, MD,
- Noud van Helmond, MD,
- Matthew N.P. Vogt, MD,
- Emily R. Whelan, BS,
- Chad C. Wiggins, PhD,
- Jeffrey L. Winters, MD,
- Arturo Casadevall, MD, PhD,
- Michael J. Joyner, MD
Affiliations
- Jonathon W. Senefeld, PhD
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN; Correspondence: Address to Jonathon W. Senefeld, PhD, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin, Louise Freer Hall Room 256, Urbana, IL, 61801.
- Ellen K. Gorman, BS
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Patrick W. Johnson, BS
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
- M. Erin Moir, PhD
- Department of Kinesiology, University of Wisconsin-Madison, Madison
- Stephen A. Klassen, PhD
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
- Rickey E. Carter, PhD
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
- Nigel S. Paneth, MD
- Department of Epidemiology and Biostatistics and Department of Pediatrics and Human Development, Michigan State University, East Lansing
- David J. Sullivan, MD
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, ML
- Olaf H. Morkeberg, BA
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- R. Scott Wright, MD
- Human Research Protection Program, Mayo Clinic, Rochester, MN; Human Research Protection Program, Mayo Clinic, Rochester, MN
- DeLisa Fairweather, PhD
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Katelyn A. Bruno, PhD
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL; Division of Cardiovascular Medicine, University of Florida, Gainesville
- Shmuel Shoham, MD
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
- Evan M. Bloch, MBChB, MS
- Department of Pathology Johns Hopkins University School of Medicine, Baltimore, ML
- Daniele Focosi, MD
- North-Western Tuscany Blood Bank, Pisa University Hospital, Italy
- Jeffrey P. Henderson, MD, PhD
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, MO; Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, MO
- Justin E. Juskewitch, MD, PhD
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
- Liise-Anne Pirofski, MD
- Division of Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Brenda J. Grossman, MD, MPH
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, MO
- Aaron A.R. Tobian, MD, PhD
- Department of Pathology Johns Hopkins University School of Medicine, Baltimore, ML
- Massimo Franchini, MD
- Division of Transfusion Medicine, Carlo Poma Hospital, Mantua, Italy
- Ravindra Ganesh, MBBS, MD
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN
- Ryan T. Hurt, MD, PhD
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN
- Neil E. Kay, MD
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Immunology, Mayo Clinic, Rochester, MN
- Sameer A. Parikh, MBBS
- Division of Hematology, Mayo Clinic, Rochester, MN
- Sarah E. Baker, PhD
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Zachary A. Buchholtz, BS
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Matthew R. Buras, BS
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ
- Andrew J. Clayburn, BS
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Joshua J. Dennis, BS
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Juan C. Diaz Soto, MD
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Vitaly Herasevich, MD, PhD
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Allan M. Klompas, MB, BCh, BAO
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Katie L. Kunze, PhD
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ
- Kathryn F. Larson, MD
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
- John R. Mills, PhD
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
- Riley J. Regimbal, BS
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Juan G. Ripoll, MD
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Matthew A. Sexton, MD
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- John R.A. Shepherd, MD
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- James R. Stubbs, MD
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
- Elitza S. Theel, PhD
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
- Camille M. van Buskirk, MD
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
- Noud van Helmond, MD
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Matthew N.P. Vogt, MD
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Emily R. Whelan, BS
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Chad C. Wiggins, PhD
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Jeffrey L. Winters, MD
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
- Arturo Casadevall, MD, PhD
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, ML
- Michael J. Joyner, MD
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Journal volume & issue
-
Vol. 7,
no. 5
pp. 499 – 513
Abstract
Objective: To examine the association of COVID-19 convalescent plasma transfusion with mortality and the differences between subgroups in hospitalized patients with COVID-19. Patients and Methods: On October 26, 2022, a systematic search was performed for clinical studies of COVID-19 convalescent plasma in the literature from January 1, 2020, to October 26, 2022. Randomized clinical trials and matched cohort studies investigating COVID-19 convalescent plasma transfusion compared with standard of care treatment or placebo among hospitalized patients with confirmed COVID-19 were included. The electronic search yielded 3841 unique records, of which 744 were considered for full-text screening. The selection process was performed independently by a panel of 5 reviewers. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were extracted by 5 independent reviewers in duplicate and pooled using an inverse-variance random effects model. The prespecified end point was all-cause mortality during hospitalization. Results: Thirty-nine randomized clinical trials enrolling 21,529 participants and 70 matched cohort studies enrolling 50,160 participants were included in the systematic review. Separate meta-analyses reported that transfusion of COVID-19 convalescent plasma was associated with a decrease in mortality compared with the control cohort for both randomized clinical trials (odds ratio [OR], 0.87; 95% CI, 0.76-1.00) and matched cohort studies (OR, 0.76; 95% CI, 0.66-0.88). The meta-analysis of subgroups revealed 2 important findings. First, treatment with convalescent plasma containing high antibody levels was associated with a decrease in mortality compared with convalescent plasma containing low antibody levels (OR, 0.85; 95% CI, 0.73 to 0.99). Second, earlier treatment with COVID-19 convalescent plasma was associated with a decrease in mortality compared with the later treatment cohort (OR, 0.63; 95% CI, 0.48 to 0.82). Conclusion: During COVID-19 convalescent plasma use was associated with a 13% reduced risk of mortality, implying a mortality benefit for hospitalized patients with COVID-19, particularly those treated with convalescent plasma containing high antibody levels treated earlier in the disease course.
