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Convalescent Plasma Efficacy in Life-Threatening COVID-19 Patients Admitted to the ICU: A Retrospective Cohort Study
Mohamed Abuzakouk1,2, Khaled Saleh3, Manuel Algora2,4
1Division of Rheumatology, Department of Internal Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates.
Insights
Convalescent plasma (CP) did not improve clinical outcomes or reduce mortality in critically ill COVID-19 patients. This study found no significant association between CP treatment and faster recovery or survival rates in the intensive care unit (ICU).
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Transfusion Medicine
Background:
- Limited data exist on convalescent plasma (CP) efficacy in critically ill COVID-19 patients.
- Investigating CP's impact on clinical outcomes in intensive care unit (ICU) settings is crucial.
Purpose of the Study:
- To determine if CP is associated with improved clinical outcomes in severe COVID-19 patients admitted to the ICU.
- To evaluate the effect of CP on time to clinical improvement and hospital mortality.
Main Methods:
- Retrospective single-center study of adult patients with laboratory-confirmed SARS-CoV-2 infection and acute respiratory failure.
- Primary outcome: time to clinical improvement within 28 days (discharge alive or 2-point disease severity scale reduction).
- Secondary outcome: hospital mortality. Analysis included adjusted models and inverse probability of treatment weighting (IPW).
Main Results:
- Of 110 patients, 32 received CP, with 62.5% receiving high-titer plasma.
- CP was not independently associated with time to clinical improvement (adjusted HR: 0.53; P=0.14) or IPW-adjusted treatment effects.
- Hospital mortality rates were similar between CP and non-CP groups (31.2% vs. 19.2%; P=0.17).
Conclusions:
- Convalescent plasma was not associated with improved clinical improvement within 28 days for critically ill COVID-19 patients.
- CP treatment did not demonstrate a significant impact on hospital mortality in this patient cohort.
- Efficacy findings remained consistent even when analyzing CP with high neutralizing antibody titers.
Abstract:
(1) Background: There are limited data regarding the efficacy of convalescent plasma (CP) in critically ill patients admitted to the intensive care unit (ICU) due to coronavirus disease 2019 (COVID-19). We aimed to determine whether CP is associated with better clinical outcome among these patients. (2) Methods: A retrospective single-center study including adult patients with laboratory-confirmed SARS-CoV-2 infection admitted to the ICU for acute respiratory failure. The primary outcome was time to clinical improvement, within 28 days, defined as patient discharged alive or reduction of 2 points on a 6-point disease severity scale. (3) Results: Overall, 110 COVID-19 patients were admitted. Thirty-two patients (29%) received CP; among them, 62.5% received at least one CP with high neutralizing antibody titers (≥1:160). Clinical improvement occurred within 28 days in 14 patients (43.7%) of the CP group vs. 48 patients (61.5%) in the non-CP group (hazard ratio (HR): 0.75 (95% CI: 0.41-1.37), p = 0.35). After adjusting for potential confounding factors, CP was not independently associated with time to clinical improvement (HR: 0.53 (95% CI: 0.23-1.22), p = 0.14). Additionally, the average treatment effects of CP, calculated using the inverse probability weights (IPW), was not associated with the primary outcome (-0.14 days (95% CI: -3.19-2.91 days), p = 0.93). Hospital mortality did not differ between CP and non-CP groups (31.2% vs. 19.2%, p = 0.17, respectively). Comparing CP with high neutralizing antibody titers to the other group yielded the same findings. (4) Conclusions: In this study of life-threatening COVID-19 patients, CP was not associated with time to clinical improvement within 28 days, or hospital mortality.
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