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Use of convalescent plasma in COVID-19 treatment: is clinical severity more important than the intervention?
Valéria de Freitas Dutra1, Heitor Duarte de Andrade1, Viviane Regina Hernandez Nunes1
1Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Insights
COVID-19 convalescent plasma transfusions did not improve outcomes for severe COVID-19 patients. Clinical severity and dialysis were significant factors influencing patient recovery and intensive care unit stay.
Area of Science:
- Immunology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) is a global health crisis.
- COVID-19 convalescent plasma (CCP) has been explored as a treatment option.
- Understanding CCP efficacy in severe COVID-19 is crucial.
Purpose of the Study:
- To compare outcomes of severe COVID-19 patients receiving CCP transfusions.
- To evaluate the impact of different CCP volumes and antibody titers.
- To identify factors influencing patient outcomes in severe COVID-19.
Main Methods:
- Retrospective cohort study at a tertiary hospital in São Paulo, Brazil.
- Inclusion of patients receiving compassionate CCP and a control group from a clinical study.
- Collection of clinical and laboratory data pre- and post-transfusion; exclusion of patients with hematological/immunological conditions.
Main Results:
- CCP transfusion did not significantly alter clinical outcomes in severe COVID-19 patients.
- Improvements in laboratory parameters were not associated with clinical benefit.
- Dialysis negatively impacted intensive care unit stay, hospitalization duration, and mechanical ventilation use.
- Higher World Health Organization (WHO) severity scores at baseline correlated with poorer outcomes.
Conclusions:
- CCP transfusion was not associated with improved clinical outcomes in severe COVID-19.
- Patient outcomes were significantly influenced by disease severity (WHO scale) and the need for dialysis.
- Further research may be needed to identify specific patient subgroups who might benefit from CCP.
Objective:
This study compared the outcomes of two cohorts of patients with coronavirus disease 2019 (COVID-19) who received COVID-19 convalescent plasma transfusions between 2020 and 2021.
Methods:
This retrospective study was conducted at a tertiary hospital in São Paulo, Brazil. We included a retrospective cohort of patients who received convalescent compassionate plasma, and another group of patients from a previous clinical study. We collected clinical and laboratory data on the day of and 5 days after transfusion. Patients with hematological or immunological conditions were excluded. Statistical significance was set at p<0.05.
Results:
COVID-19 convalescent plasma did not affect the outcomes of patients with severe COVID-19 when comparing the two cohorts transfused with different volumes and titers of neutralizing antibodies. Despite improvements in some laboratory parameters, no effect on clinical outcomes was observed. Dialysis negatively affected the length of intensive care unit stay, hospitalization, and mechanical ventilation use. Each higher point on the day 0 World Health Organization scale reduced the probability of hospital and intensive care unit discharge and the risk of mechanical ventilation discontinuation.
Conclusion:
Dialysis and the assessed clinical severity represented by the World Health Organization scale on day 0 influenced the outcomes, whereas COVID-19 convalescent plasma transfusion did not.
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