Convalescent Plasma Transfusion In Severe Covid-19 Patients Admitted To Intensive Care Unit: A Single Center Study

Abstract

Initial difficult times of novel coronavirus disease 2019 (COVID-19) had clinicians actively seeking appropriate treatment. Convalescent plasma (CP) has been studied for treatment of past coronavirus pandemics and was successful with promising efficacy and safety. This study aims to measure the efficacy of convalescent plasma transfusion in severe COVID-19 patients, determined by alleviation of symptoms, improvement in radiologic findings, and laboratory parameters. Cross-sectional study conducted involving 23 severe COVID-19 patients admitted to Udayana University Hospital intensive care unit in 2020. Patients received a minimum 200 mL CP transfusion, dexamethasone, and remdesivir. Data were retrieved from patient’s medical records. Patients mean age was 54.04 years. Mean time from onset of illness to transfusion and length of stay were 11.09 and 16.70 days respectively. No adverse effects were observed during treatment. Twelve patients (52.2%) showed alleviation of symptoms and recovered, with 15 days median time from transfusion to recovery. Post-transfusion chest x-ray examination showed varying degrees of absorption of lung lesions in 10 patients (43.5%) and was associated with the patient’s outcome (p = 0.001). Significant changes in c-reactive protein (p = 0.000) and procalcitonin level (p = 0.024) was found as compared to pretransfusion. Despite these findings, almost half the patients (47.8%) did not receive benefits from CP transfusion and dead. CP transfusion has shown remarkable improvement in radiologic, inflammatory, and prognostic parameters but was unable to improve patient clinical outcomes and mortality rate.

Keywords

• convalescent plasma therapy
• COVID-19
• critical care
• outcome

References

1. 1. Surendra H, Elyazar IR, Djaafara BA, Ekawati LL, Saraswati K, Adrian V, et al. Clinical characteristics and mortality associated with COVID-19 in Jakarta, Indonesia: A hospital-based retrospective cohort study. Lancet Reg Heal - West Pacific. 2021;9:100108.
2. 2. Masyeni S, Nelwan EJ, Fatawy RM, Wibawa S, Nugraha PA, Antara J, et al. Clinical characteristics and outcomes of COVID-19 patients in Bali, Indonesia. PLoS One. 2022;17(6 June):1–15.
3. 3. Brahmantya IBY, Purnamasidhi CAW, Sumardika IW. COVID-19 pharmacological treatment at the Udayana University Hospital in april-may 2020. Biomed Pharmacol J. 2021;14(2):971–7.
4. 4. Erlina Burhan, Agus Dwi Susanto, Sally A Nasution, Eka Ginanjar, Ceva Wicaksono Pitoyo AS, Firdaus I, et al. COVID-19 Management Guideline. 2nd ed. 2020. 29–32 p.
5. 5. Cheng Y, Wong R, Soo YOY, Wong WS, Lee CK, Ng MHL, et al. Use of convalescent plasma therapy in SARS patients in Hong Kong. Eur J Clin Microbiol Infect Dis. 2005 Jan 23;24(1):44–6.
6. 6. Zhou B, Zhong N, Guan Y. Treatment with Convalescent Plasma for Influenza A (H5N1) Infection. N Engl J Med. 2007 Oct 4;357(14):1450–1.
7. 7. Hung IFN, To KKW, Lee C-K, Lee K-L, Chan K, Yan W-W, et al. Convalescent Plasma Treatment Reduced Mortality in Patients With Severe Pandemic Influenza A (H1N1) 2009 Virus Infection. Clin Infect Dis. 2011 Feb 15;52(4):447–56.
8. 8. Ko J-H, Seok H, Cho SY, Ha YE, Baek JY, Kim SH, et al. Challenges of Convalescent Plasma Infusion Therapy in Middle East Respiratory Coronavirus Infection: A Single Centre Experience. Antivir Ther. 2018 Oct 1;23(7):617–22.

9. 9. Mair-Jenkins J, Saavedra-Campos M, Baillie JK, Cleary P, Khaw F-M, Lim WS, 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 Jan 1;211(1):80–90.
10. 10. Chen L, Xiong J, Bao L, Shi Y. Convalescent plasma as a potential therapy for COVID-19. Lancet Infect Dis. 2020;20(4):398–400.
11. 11. Rajendran K, Krishnasamy N, Rangarajan J, Rathinam J, Natarajan M, Ramachandran A. Convalescent plasma transfusion for the treatment of COVID-19: Systematic review. J Med Virol. 2020;92(9):1475–83.
12. 12. World Health Organization. WHO recommends against the use of convalescent plasma to treat COVID-19 [Internet]. 2021 [cited 2022 Oct 9]. p. 2–3. Available from: https://www.who.int/news/item/07-12-2021-who-recommends-against-the-use-of-convalescent-plasma-to-treat-covid-19
13. 13. Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes [Internet]. 2017 Jan 3 [cited 2022 Oct 17];10(1):1–4. Available from: /pmc/articles/PMC5217256/
14. 14. Li L, Zhang W, Hu Y, Tong X, Zheng S, Yang J, et al. Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19. JAMA [Internet]. 2020 Aug 4;324(5):460. Available from: https://jamanetwork.com/journals/jama/fullarticle/2766943
15. 15. Simonovich VA, Burgos Pratx LD, Scibona P, Beruto MV, Vallone MG, Vázquez C, et al. A Randomized Trial of Convalescent Plasma in Covid-19 Severe Pneumonia. N Engl J Med. 2021 Feb 18;384(7):619–29.
16. 16. Agarwal A, Mukherjee A, Kumar G, Chatterjee P, Bhatnagar T, Malhotra P. Convalescent plasma in the management of moderate covid-19 in adults in India: open label phase II multicentre randomised controlled trial (PLACID Trial). BMJ. 2020 Oct 22;371:m3939.
17. 17. Piechotta V, Iannizzi C, Chai KL, Valk SJ, Kimber C, Dorando E, et al. Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review. Cochrane Database Syst Rev [Internet]. 2021 May 20 [cited 2022 Oct 16];2021(5). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013600.pub4/full
18. 18. Dzik S. COVID-19 Convalescent Plasma: Now Is the Time for Better Science. Transfus Med Rev [Internet]. 2020 Jul 1 [cited 2022 Oct 16];34(3):141. Available from: /pmc/articles/PMC7177063/.