ABSTRACT
The use of convalescent plasma against SARS-CoV-2 has been suggested as one of the treatments of patients with coronavirus disease 19 (Covid-19). We assess the security and efectivity of the treatment with CP in severe or potentially severe covid-19 disease. We assess the mortality rate in this patients by precocity of plasma transfusion, sex and WHO Ordinal Scale for Clinical Improvement. The administration of CP has had an adverse event rate very low. In those patients who had an early CP transfusion, the mortality rate is much lower. Possibly the elapsed time from symptom onset is the most important factor to assess efectivity. Patients with a higher score in the WHO Ordinal Scale for Clinical Improvement present higher mortality rates, probably similar to patients with Covid-19 treated with other therapeutic options. The mortality rate by sex was similar in both groups as we can observe in other studies. An early CP administration could be a therapeutic option in severe patients with Covid19 considering that is a safe procedure that can improve survival rates.
The use of convalescent plasma against SARS-CoV-2 has been suggested as one of the treatments of patients with coronavirus disease 19 (Covid-19). We assess the security and efectivity of the treatment with CP in severe or potentially severe covid-19 disease. We assess the mortality rate in this patients by precocity of plasma transfusion, sex and WHO Ordinal Scale for Clinical Improvement. The administration of CP has had an adverse event rate very low. In those patients who had an early CP transfusion, the mortality rate is much lower. Possibly the elapsed time from symptom onset is the most important factor to assess efectivity. Patients with a higher score in the WHO Ordinal Scale for Clinical Improvement present higher mortality rates, probably similar to patients with Covid-19 treated with other therapeutic options. The mortality rate by sex was similar in both groups as we can observe in other studies. An early CP administration could be a therapeutic option in severe patients with Covid19 considering that is a safe procedure that can improve survival rates.
INTRODUCTION
Passive immunotherapy has been widely used previously to treat severe acute respiratory syndrome (SARS), Middle East respiratory syndrome, Influenza A and Ebola virus disease with encouraging results. The use of convalescent plasma against SARS-CoV-2 has been suggested as one of the treatments of patients with coronavirus disease 19 (Covid-19), specially as an early intervention.
Passive immunotherapy has been widely used previously to treat severe acute respiratory syndrome (SARS), Middle East respiratory syndrome, Influenza A and Ebola virus disease with encouraging results. The use of convalescent plasma against SARS-CoV-2 has been suggested as one of the treatments of patients with coronavirus disease 19 (Covid-19), specially as an early intervention.
METHOD
We assess the security and efectivity of the treatment with CP in severe or potentially severe covid-19 disease.We collect the data of all patients with Covid-19 who were treated with covalescent plasma (CP) in our hospital from April 2020 to February 2021. First of all, we assess the security of CP transfusion and then, we assess the efectivity of the CP transfusion. We assess the mortality rate in this patients by precocity of plasma transfusion, sex and WHO Ordinal Scale for Clinical Improvement.
We assess the security and efectivity of the treatment with CP in severe or potentially severe covid-19 disease.We collect the data of all patients with Covid-19 who were treated with covalescent plasma (CP) in our hospital from April 2020 to February 2021. First of all, we assess the security of CP transfusion and then, we assess the efectivity of the CP transfusion. We assess the mortality rate in this patients by precocity of plasma transfusion, sex and WHO Ordinal Scale for Clinical Improvement.
RESULT
Between April 2020 and February 2021, a total of 44 patients with Covid-19 were treated with CP in our hospital. 77.27% (n=34) were male and 22.73% (n=10) were female with a median age of 65 (28-92). Mortality rate by sex was 32.35% (n=11) in male and 30% (n=3) in female. In terms of security one of the patiens developed a mild rash that was managed with antihistamine and had a complete resolution. In terms of precocity of CP administration we separated the patients into two different groups. The first one, with those patients who had an early CP transfusion (ten days or less after symptom onsent) and the second one, with patients who had a late CP transfusion (more than ten days after symptom onsent). 56.80% (n=25) had and early CP administration, while 43.20% (n=19) of the patients had a late one. Mortality rate in the first group was 16% (n=4) and 52.63% (n=11) in the second one.According to the WHO Ordinal Scale for Clinical Improvement, patients with a score of 6 (intubated or mechanical ventilation) or higher were 12; patients with a score of 5 (non-invasive ventilation or high-flow oxygen) were 13, and patients with a score of 4 (oxygen by mask or nasal prongs) were 19. In our center, the mortality rate of these groups of patients was 50% (n=6), 38% (n=5) and 16% (n=3) respectively.
Between April 2020 and February 2021, a total of 44 patients with Covid-19 were treated with CP in our hospital. 77.27% (n=34) were male and 22.73% (n=10) were female with a median age of 65 (28-92). Mortality rate by sex was 32.35% (n=11) in male and 30% (n=3) in female. In terms of security one of the patiens developed a mild rash that was managed with antihistamine and had a complete resolution. In terms of precocity of CP administration we separated the patients into two different groups. The first one, with those patients who had an early CP transfusion (ten days or less after symptom onsent) and the second one, with patients who had a late CP transfusion (more than ten days after symptom onsent). 56.80% (n=25) had and early CP administration, while 43.20% (n=19) of the patients had a late one. Mortality rate in the first group was 16% (n=4) and 52.63% (n=11) in the second one.According to the WHO Ordinal Scale for Clinical Improvement, patients with a score of 6 (intubated or mechanical ventilation) or higher were 12; patients with a score of 5 (non-invasive ventilation or high-flow oxygen) were 13, and patients with a score of 4 (oxygen by mask or nasal prongs) were 19. In our center, the mortality rate of these groups of patients was 50% (n=6), 38% (n=5) and 16% (n=3) respectively.
CONCLUSION
In this 44 patients group, the administration of CP has had an adverse event rate very low, similar to non convalescent plasma trasfusion adverse event rate.In those patients who had an early CP transfusion, the mortality rate is much lower than those who had a late CP transfusion. Possibly the elapsed time from symptomonset is the most important factor to assess efectivity. Mortality rate by WHO Ordinal Scale for Clinical Improvement shows differences between groups. Those patients with a higher score present higher mortality rates, probably similar to patients with Covid-19 treated with other therapeutic options. The mortality rate by sex was similar in both groups as we can observe in other studies. An early CP administration could be a therapeutic option in severe patients with Covid19 considering that is a safe procedure that can improve survival rates.
In this 44 patients group, the administration of CP has had an adverse event rate very low, similar to non convalescent plasma trasfusion adverse event rate.In those patients who had an early CP transfusion, the mortality rate is much lower than those who had a late CP transfusion. Possibly the elapsed time from symptomonset is the most important factor to assess efectivity. Mortality rate by WHO Ordinal Scale for Clinical Improvement shows differences between groups. Those patients with a higher score present higher mortality rates, probably similar to patients with Covid-19 treated with other therapeutic options. The mortality rate by sex was similar in both groups as we can observe in other studies. An early CP administration could be a therapeutic option in severe patients with Covid19 considering that is a safe procedure that can improve survival rates.
REFERENCES
1) Louis M. Katz, M.D. (A Little) Clarity on Convalescent Plasma for Covid-19N Engl J Med 2021; 384:666-668
2) Libster R, Pérez Marc G, Wappner D, et al. Early high-titer plasma therapy to prevent severe Covid-19 in older adults. N EnglJ Med 2021;384:610-618.
3) Salazar E, Christensen PA, Graviss EA, et al. Treatment of COVID-19 patients with convalescent plasma reveals a signal ofsignificantly decreased mortality. Am J Pathol 2020;190:2290-2303.
4) Li L, Zhang W, Hu Y, et al. Effect of convalescent plasma therapy on time to clinical improvement in patients with severe andlife-threatening covid-19 a randomized clinical trial. JAMA 2020;324:460-470.
5) Mair-Jenkins J, Saavedra-Campos M, Baillie JK, et al. The effectiveness of convalescent plasma and hyperimmuneimmunoglobulin 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.
1) Louis M. Katz, M.D. (A Little) Clarity on Convalescent Plasma for Covid-19N Engl J Med 2021; 384:666-668
2) Libster R, Pérez Marc G, Wappner D, et al. Early high-titer plasma therapy to prevent severe Covid-19 in older adults. N EnglJ Med 2021;384:610-618.
3) Salazar E, Christensen PA, Graviss EA, et al. Treatment of COVID-19 patients with convalescent plasma reveals a signal ofsignificantly decreased mortality. Am J Pathol 2020;190:2290-2303.
4) Li L, Zhang W, Hu Y, et al. Effect of convalescent plasma therapy on time to clinical improvement in patients with severe andlife-threatening covid-19 a randomized clinical trial. JAMA 2020;324:460-470.
5) Mair-Jenkins J, Saavedra-Campos M, Baillie JK, et al. The effectiveness of convalescent plasma and hyperimmuneimmunoglobulin 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.
The data in this poster was presented at EHA 2021. Published with permission from the Copyright owner.