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Updated: Jun 18, 2025
Author Spotlight: Advancing the Analysis of Plasma Extracellular Vesicle Proteome for Cardiovascular Biomarker Studies
Published on: January 31, 2025
Convalescent plasma and predictors of mortality among hospitalized patients with COVID-19: a systematic review and
Massimo Franchini1, Mario Cruciani1, Carlo Mengoli1
1Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantua, Italy.
Background:
Plasma collected from recovered patients with COVID-19 (COVID-19 convalescent plasma [CCP]) was the first antibody-based therapy employed to fight the COVID-19 pandemic. While the therapeutic effect of early administration of CCP in COVID-19 outpatients has been recognized, conflicting data exist regarding the efficacy of CCP administration in hospitalized patients.
Objectives:
To examine the effect of CCP compared to placebo or standard treatment, and to evaluate whether time from onset of symptoms to treatment initiation influenced the effect.
Data Sources:
Electronic databases were searched for studies published from January 2020 to January 2024.
Study Eligibility Criteria:
Randomized clinical trials (RCTs) investigating the effect of CCP on COVID-19 mortality in hospitalized patients with COVID-19.
Participants:
Hospitalized patients with COVID-19.
Interventions:
CCP versus no CCP.
Assessment Of Risk Of Bias:
Cochrane risk of bias tool for RCTs.
Methods Of Data Synthesis:
The random-effects model was used to calculate the pooled risk ratio (RR) with 95% CI for the pooled effect estimates of CCP treatment. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the certainty of evidence.
Results:
Twenty-seven RCTs were included, representing 18,877 hospitalized patients with COVID-19. When transfused within 7 days from symptom onset, CCP significantly reduced the risk of death compared to standard therapy or placebo (RR, 0.76; 95% CI, 0.61-0.95), while later CCP administration was not associated with a mortality benefit (RR, 0.98; 95% CI, 0.90-1.06). The certainty of the evidence was graded as moderate. Meta-regression analysis demonstrated increasing mortality effects for longer interval to transfusion or worse initial clinical severity.
Conclusions:
In-hospital transfusion of CCP within 7 days from symptom onset conferred a mortality benefit.
