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Convalescent Plasma in Older Adults with COVID-19: A Systematic Review and Meta-Analysis
I Gusti Putu Suka Aryana1, Dian Daniella2, Ivana Beatrice Paulus3
1Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Udayana University, Bali, Denpasar, Indonesia.
Insights
Convalescent plasma (CP) significantly reduces mortality risk in older adults with COVID-19. Early administration, within 72 hours of symptom onset, yields the best outcomes for this vulnerable population.
Area of Science:
- Infectious Diseases
- Gerontology
- Hematology
Background:
- Older adults experienced the highest COVID-19 mortality rates (80-90%).
- Convalescent plasma (CP) efficacy in older adults is less understood than in younger adults.
- Data on therapeutic CP effectiveness in elderly COVID-19 patients is needed.
Purpose of the Study:
- To evaluate the efficacy of convalescent plasma (CP) in reducing mortality among older adults with COVID-19.
- To analyze the impact of CP timing and disease severity on outcomes in elderly COVID-19 patients.
Main Methods:
- A meta-analysis of literature from December 2019 to April 2022.
- Included studies were sourced from Cochrane, PubMed, and Google Scholar.
- Analyzed all-cause mortality using random-effects models and assessed risk of bias.
Main Results:
- Three studies with 1,038 patients met inclusion criteria.
- CP administration significantly lowered mortality risk in older adults (RR=0.47; p=0.01).
- CP was more effective when given early (within 72 hours) and in less severe disease stages.
Conclusions:
- Convalescent plasma treatment is associated with significantly reduced mortality in older adults with COVID-19.
- Early CP administration (within 72 hours) is critical for a better prognosis.
- High-titer CP may also contribute to lower mortality rates.
Background:
Among all patients infected with coronavirus disease 2019 (COVID-19), the older adult population was the most affected, with 80%-90% of fatalities occurring in this group. The effectiveness of convalescent plasma (CP) in older adults is considerably more restricted than that in adults, resulting in a demand for data on the efficacy of therapeutic CP in older adults. This meta-analysis of updated literature examined the effect of CP in older adults with COVID-19.
Methods:
Relevant literature was identified from studies indexed in the Cochrane, PubMed, and Google Scholar databases between December 2019 and April 2022. The primary outcome was all-cause mortality. Risk estimates were pooled using a random-effects model. The risk of bias was assessed by regression-based Egger test using the relative risk (RR) and upper and lower confidence intervals (CIs) of the three included studies.
Results:
Among 377 studies identified, three full-text studies that included 1,038 patients met the inclusion criteria. The results of our meta-analysis showed that CP administration lowered the mortality risk in older adults with COVID-19 (RR=0.47; 95% CI, 0.26-0.86; p=0.01; I2=0%, p<0.81). CP therapy was more useful if delivered early in the course of the disease (within 72 hours of onset) and in less severe stages of the disease. Mortality tended to be lower in the high-titer group.
Conclusions:
CP treatment was significantly associated with a lower risk of mortality in older adults with COVID-19 than in patients not administered CP. The timing of CP administration is critical since earlier treatment after disease onset was associated with a better prognosis.
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