在机械通风患者中治疗COVID-19引起的ARDS的康复性血
Benoît Misset1, Michael Piagnerelli1, Eric Hoste1
1From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium.
对于患有急性呼吸困难综合征 (ARDS) 的COVID-19患者的康复性血治疗显著降低了28天死亡率. 当机械通风启动后48小时内服用时,这种益处最为明显.
科学领域:
- 临界护理医学 临界护理医学
- 传染性疾病 传染性疾病
- 免疫学 免疫学 免疫学
背景情况:
- 使用康复性血的被动免疫是COVID-19的公认治疗方法.
- 关于其在COVID-19引起的急性呼吸窘迫综合征 (ARDS) 患者的疗效的数据有限.
研究的目的:
- 评估康复期血在减少COVID-19诱导的ARDS接受侵入性机械通风的成年患者死亡率方面的有效性.
主要方法:
- 一项开放的随机试验分配了475名患有COVID-19诱导的ARDS的成年患者,接受康复性血 (中和抗体标位≥1:320) 或标准治疗.
- 随机化按输管到纳入的时间分层,主要结果是28天死亡率.
主要成果:
- 康复期血组28日死亡率为35.4%,标准治疗组为45.0% (P=0.03).
- 这种益处主要在机械通风启动后48小时内随机选择的患者中观察到.
- 严重的不良事件在两组之间是可比的.
结论:
- 康复性血,中和抗体标位至少为1:160,在机械通风5天内显著降低了COVID-19引起的ARDS患者的28天死亡率.
- 在开始通风后48小时内接受治疗的患者中,积极效应最为显著.
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