Our convalescent plasma experiences in COVID-19 patients hospitalized in the intensive care unit

Year 2022, Volume: 5 Issue: 2, 600 - 606, 15.03.2022

Bülent Barış Güven , Tuna Ertürk , Egemen Yıldız , Esra Durmayüksel , Aysin Ersoy , Alpaslan Tanoğlu

https://doi.org/10.32322/jhsm.1068864

Cited By: 4

Abstract

Objective: Despite vaccine and drug studies, convalescent plasma (CP) therapy remains an alternative treatment for coronavirus disease 2019 (COVID-19). In this study, we aimed to reveal the efficacy of CP therapy on mortality and the factors affecting it for the patients diagnosed with COVID-19 and acute respiratory distress syndrome (ARDS) which were followed in our intensive care unit (ICU).
Material and Method: The data (demographic characteristics, the amount of CP used, PaO2/FiO2, leukocyte, neutrophil, lymphocyte, D-Dimer, C-reactive protein (CRP), procalcitonin, ferritin values, and the clinical findings) of the patients who were hospitalized in the ICU with the diagnosis of COVID-19 and received CP treatment between 20 March and 20 October 2020 were analyzed retrospectively. Data of deceased patients (n=29) and survivors (n=50) were compared with each other and logistic regression analysis was performed to investigate the relationship with mortality.
Results: 79 patients who received 166 units of CP therapy after a mean of 13.45±3.6 days symptom onset, were identified. 96.2% of the patients had at least one concomitant disease. Mortality was observed in 29 (36.7%) of the patients. Mortality (5.1%) was less common in those receiving CP therapy within the first 14 days after the onset of symptoms. Patient age (p=0.041), neutrophil/lymphocyte ratio (p=0.004), CRP values (p=0.002), the number of comorbidities (p<0.001), PaO2/FiO2 ratio before CP (p=0.005), and the period when CP was first infused from symptom onset (p<0.001) had a statistically significant effect on mortality.
Conclusion: CP can be safely used to treat COVID-19. However, its positive effect is less observed in patients with the advanced stage of the disease, progressive deterioration of oxygenation, and a high number of comorbidities. For this reason, starting CP treatment at an early stage may increase its effectiveness.

Keywords

Convalescent (immune) plasma, COVID-19, Intensive care unit, SARS-Cov-2

References

• Mair-Jenkins J, Saavedra-Campos M, Baillie JK, et al. The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. J Infect Dis 2015; 211: 80-90.
• Arabi YM, Hajeer AH, Luke T, et al. Feasibility of using convalescent plasma immunotherapy for MERS-CoV infection. Saudi Arabia. Emerg Infect Dis 2016; 22: 1554-61.
• Van Griensven J, De Weiggheleire A, Delamou A, et al. The use of ebola convalescent plasma to treat ebola virus disease in resource-constrained settings: a perspective from the field. Clin Infect Dis 2016; 62: 69-74.
• Li L, Zhang W, Hu Y, et al. Effect of convalescent plasma therapy on time to clinical improvement in patients with severe and life-threatening COVID-19: a randomized clinical trial. JAMA 2020; 324: 460-70.
• U.S Food & Drug Administration Recommendations for Investigational COVID-19 Convalescent Plasma. Available from: https://www.fda.gov/vaccines-blood-biologics/ investigational-new-drug-applications-inds-cber-regulated-products/recommendations-investigational-covid-19-convalescent-plasma [accessed 11 September 2021]
• Janiaud P, Axfors C, Schmitt AM, et al. Association of convalescent plasma treatment with clinical outcomes in patients with COVID-19: a systematic review and meta-analysis. JAMA 2021; 325: 1185-95.
• Our World in data. Coronavirus (COVID-19) vaccinations. https://ourworldindata.org/covid-vaccinations [accessed 01 December 2021]
• Casadevall A, Dadachova E, Pirofski LA. Passive antibody therapy for infectious diseases. Nat Rev Microbiol 2004; 2: 695–703.
• Cheng Y, Wong R, Soo YO, et al. Use of convalescent plasma therapy in SARS patients in Hong Kong. Eur J Clin Microbiol Infect Dis 2005; 24: 44–6.
• Mair-Jenkins J, Saavedra-Campos M, Baillie JK, et al. The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. J Infect Dis 2015; 211: 80–90.
• Casadevall A, Pirofski LA. The convalescent sera option for containing COVID-19. J Clin Invest 2020; 130: 1545-8.
• Bloch EM, Shoham S, Casadevall A, et al. Deployment of convalescent plasma for the prevention and treatment of COVID-19. J Clin Invest 2020; 130: 2757-65.
• WHO Blood Regulators Network (BRN), “Interim Position Paper on blood regulatory response to the evolving out-break of the 2019 novel coronavirus SARS-CoV-2.” http://www.transfusion.ru/2020/04-03-3.pdf [accessed 19 September 2021]
• Ersoy A, Güven BB, Ertürk T et al. Assessment of the efficacy of spironolactone for COVID-19 ARDS patients. Aydın Sağlık Dergisi 2021; 7: 191-209
• Salazar E, Christensen PA, Graviss EA, et al. Significantly Decreased Mortality in a Large Cohort of Coronavirus Disease 2019 (COVID-19) Patients Transfused Early with Convalescent Plasma Containing High-Titer Anti-Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Spike Protein IgG. Am J Pathol 2021; 191: 90-107.
• Joyner MJ, Senefeld JW, Klassen SA, et al. Effect of Convalescent Plasma on Mortality among Hospitalized Patients with COVID-19: Initial Three-Month Experience. Preprint. medRxiv 2020; 2020.08.12.20169359.
• Covıd-19 İmmün (Konvalesan) Plazma Tedarik ve Klinik Kullanım Rehberi 2020. Available from: https://shgmkanhizmetleridb.saglik.gov.tr/Eklenti/39167/0/covid-19-immun-plazma-rehberi-v5.pdf [accessed 11 September 2021]
• Lagunas-Rangel FA. Neutrophil-to lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID19): A meta-analysis. J Med Virol 2020; 92: 1733-4.
• Wang L. C-reactive protein levels in the early stage of COVID-19. Med Maladies Infect 2020; 50: 332-3.
• Albitar O, Ballouze R, Ooi JP, Sheikh Ghadzi SM. Risk factors for mortality among COVID-19 patients. Diabetes Res Clin Pract 2020; 166: 108293.
• Erkurt MA, Sarici A, Berber İ, Kuku İ, Kaya E, Özgül M. Life-saving effect of convalescent plasma treatment in covid-19 disease: Clinical trial from eastern Anatolia. Transfus Apher Sci 2020; 59: 102867.
• Roback JD, Guarner J. Convalescent plasma to treat COVID-19: possibilities and challenges. JAMA 2020; 323: 1561-2.
• Klassen SA, Senefeld JW, Senese KA, et al. Convalescent plasma therapy for COVID-19: a graphical mosaic of the worldwide evidence. Front Med (Lausanne) 2021; 8: 684151.
• Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progression. Crit Rev Clin Lab Sci 2020; 57: 389-99.
• Yufei Y, Mingli L, Xuejiao L, et al. Utility of the neutrophil-to-lymphocyte ratio and C-reactive protein level for coronavirus disease 2019 (COVID-19). Scand J Clin Lab Invest 2020; 80: 536-40.
• Gu Y, Wang D, Chen C, et al. PaO2/FiO2 and IL-6 are risk factors of mortality for intensive care COVID-19 patients. Sci Rep 11, 7334 (2021). https://doi.org/10.1038/s41598-021-86676-3
• Şahin Özdemirel T, Akkurt ES, Ertan Ö, Gökler ME, Akıncı Özyürek B. Complications with moderate-to-severe COVID-19 during hospital admissions in patients with pneumonia. J Health Sci Med 2021; 4: 766-71.
• Güngörer B. Baseline demographic, clinical and laboratory risk factors for predicting admission to intensive care unit in patients diagnosed with COVID-19 in the emergency department. Anatolian Curr Med J 2021; 3; 279-83
• Ertan Ö, Akkurt ES, Şahin Özdemirel T, Akıncı Özyürek B. A rare case: acute ischemic stroke that developed in a case with severe COVID-19 pneumonia. Anatolian Curr Med J 2021; 3; 256-8
• Yang Z, Hu Q, Huang F, Xiong S, Sun Y. The prognostic value of the SOFA score in patients with COVID-19: A retrospective, observational study. Medicine (Baltimore) 2021; 100:e26900.
• Joyner MJ, Wright RS, Fairweather D, et al. Early safety indicators of COVID-19 convalescent plasma in 5000 patients. J Clin Invest 2020; 130: 4791-7.