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Effectiveness of convalescent plasma in Indian patients with COVID-19
Sandeep Budhiraja1, Arun Dewan2, Ritesh Aggarwal2
1Clinical Directorate, Max Healthcare, New Delhi, India; Institute of Internal Medicine, Max Healthcare, New Delhi, India.
Insights
Convalescent plasma (CP) reduced mortality in elderly, ICU-admitted COVID-19 patients, especially those with comorbidities or requiring ventilation. This treatment showed significant benefits for older females needing respiratory support.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Hematology
Background:
- Convalescent plasma (CP) is an emerging treatment for hospitalized COVID-19 patients.
- Existing evidence on CP's efficacy in reducing COVID-19 mortality remains inconclusive.
Purpose of the Study:
- To investigate the impact of CP on 28-day mortality in COVID-19 patients.
- To identify specific patient subgroups that may benefit from CP therapy.
Main Methods:
- A multi-center, retrospective case-control observational study involving 1079 adult COVID-19 patients.
- Comparison of mortality rates between patients receiving CP plus supportive care and those receiving supportive care alone.
- Analysis stratified by patient demographics, disease severity, and ventilation status.
Main Results:
- Overall mortality was not significantly different between groups (18.5% vs 22.4%).
- CP significantly reduced mortality in ICU-admitted patients (25.5% vs 33.2%), particularly in those aged 60-74 years, females, patients with comorbidities, and those requiring mechanical ventilation.
- Mortality reduction was most pronounced in patients on invasive mechanical ventilation (37.2% vs 49.3%).
Conclusions:
- CP use is associated with reduced mortality in elderly, ICU-admitted COVID-19 patients (≥60 years).
- Benefits were particularly noted in females, patients with comorbidities, and those requiring ventilation.
- CP may be a valuable therapeutic option for specific high-risk COVID-19 patient populations.
Background:
Convalescent plasma (CP) is being used as a treatment option in hospitalized patients with COVID-19. Till date, there is conflicting evidence on efficacy of CP in reducing COVID-19 related mortality.
Objective:
To evaluate the effect of CP on 28-day mortality reduction in patients with COVID-19.
Methods:
We did a multi-centre, retrospective case control observational study from 1st May 2020 to 31st August 2020. A total of 1079 adult patients with moderate and severe COVID-19 requiring oxygen, were reviewed. Of these, 694 patients were admitted to ICU. Out of these, 333 were given CP along with best supportive care and remaining 361 received best supportive care only.
Results:
In the overall group of 1079 patients, mortality in plasma vs no plasma group was statistically not significant (22.4% vs 18.5%; p = 0.125; OR = 1.27, 95% CI: 0.94--1.72). However, in patients with COVID-19 admitted to ICU, mortality was significantly lower in plasma group (25.5% vs 33.2%; p = 0.026; OR = 0.69, 95%CI: 0.50-0.96). This benefit of reduced mortality was most seen in age group 60 to 74 years (26.7% vs 43.0%; p = 0.004; OR = 0.48, 95% CI: 0.29-0.80), driven mostly by females of this age group (23.1% vs 53.5%; p = 0.013; OR = 0.26, 95% CI: 0.09-0.78). Significant difference in mortality was observed in patients with one comorbidity (22.3% vs 36.5%; p = 0.004; OR = 0.50, 95% CI: 0.31-0.80). Moreover, patients on ventilator had significantly lower mortality in the plasma arm (37.2% vs 49.3%; p = 0.009; OR = 0.61, 95% CI: 0.42-0.89); particularly so for patients on invasive mechanical ventilation (63.9% vs 82.9%; p = 0.014; OR = 0.37, 95% CI: 0.16-0.83).
Conclusion:
The use of CP was associated with reduced mortality in COVID-19 elderly patients admitted in ICU, above 60 years of age, particularly females, those with comorbidities and especially those who required some form of ventilation.
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