Multi-center matched cohort study of convalescent plasma for hospitalized patients with COVID-19.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2022
2022
Historique:
received:
25
03
2022
accepted:
04
08
2022
entrez:
18
8
2022
pubmed:
19
8
2022
medline:
23
8
2022
Statut:
epublish
Résumé
Although frequently used in the early pandemic, data on the effectiveness of COVID-19 convalescent plasma (CCP) remain mixed. We investigated the effectiveness and safety of CCP in hospitalized COVID-19 patients in real-world practices during the first two waves of the pandemic in a multi-hospital healthcare system in Texas. Among 11,322 hospitalized patients with confirmed COVID-19 infection from July 1, 2020 to April 15, 2021, we included patients who received CCP and matched them with those who did not receive CCP within ±2 days of the transfusion date across sites within strata of sex, age groups, days and use of dexamethasone from hospital admission to the match date, and oxygen requirements 4-12 hours prior to the match date. Cox proportional hazards model estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for effectiveness outcomes in a propensity score 1:1 matched cohort. Pre-defined safety outcomes were described. We included 1,245 patients each in the CCP treated and untreated groups. Oxygen support was required by 93% of patients at the baseline. The pre-defined primary effectiveness outcome of 28-day in-hospital all-cause mortality (HR = 0.85; 95%CI: 0.66,1.10) were similar between treatment groups. Sensitivity and stratified analyses found similar null results. CCP-treated patients were less likely to be discharged alive (HR = 0.82; 95%CI: 0.74, 0.91), and more likely to receive mechanical ventilation (HR = 1.48; 95%CI: 1.12, 1.96). Safety outcomes were rare and similar between treatment groups. The findings in this large, matched cohort of patients hospitalized with COVID-19 and mostly requiring oxygen support at the time of treatment, do not support a clinical benefit in 28-day in-hospital all-cause mortality for CCP. Future studies should assess the potential benefits with specifically high-titer units in perhaps certain subgroups of patients (e.g. those with early disease or immunocompromised).
Sections du résumé
BACKGROUND
Although frequently used in the early pandemic, data on the effectiveness of COVID-19 convalescent plasma (CCP) remain mixed. We investigated the effectiveness and safety of CCP in hospitalized COVID-19 patients in real-world practices during the first two waves of the pandemic in a multi-hospital healthcare system in Texas.
METHODS AND FINDINGS
Among 11,322 hospitalized patients with confirmed COVID-19 infection from July 1, 2020 to April 15, 2021, we included patients who received CCP and matched them with those who did not receive CCP within ±2 days of the transfusion date across sites within strata of sex, age groups, days and use of dexamethasone from hospital admission to the match date, and oxygen requirements 4-12 hours prior to the match date. Cox proportional hazards model estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for effectiveness outcomes in a propensity score 1:1 matched cohort. Pre-defined safety outcomes were described. We included 1,245 patients each in the CCP treated and untreated groups. Oxygen support was required by 93% of patients at the baseline. The pre-defined primary effectiveness outcome of 28-day in-hospital all-cause mortality (HR = 0.85; 95%CI: 0.66,1.10) were similar between treatment groups. Sensitivity and stratified analyses found similar null results. CCP-treated patients were less likely to be discharged alive (HR = 0.82; 95%CI: 0.74, 0.91), and more likely to receive mechanical ventilation (HR = 1.48; 95%CI: 1.12, 1.96). Safety outcomes were rare and similar between treatment groups.
CONCLUSION
The findings in this large, matched cohort of patients hospitalized with COVID-19 and mostly requiring oxygen support at the time of treatment, do not support a clinical benefit in 28-day in-hospital all-cause mortality for CCP. Future studies should assess the potential benefits with specifically high-titer units in perhaps certain subgroups of patients (e.g. those with early disease or immunocompromised).
Identifiants
pubmed: 35980913
doi: 10.1371/journal.pone.0273223
pii: PONE-D-22-08925
pmc: PMC9387784
doi:
Substances chimiques
Oxygen
S88TT14065
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0273223Déclaration de conflit d'intérêts
The authors have declared that no conflict of interest exists.
Références
Expert Rev Hematol. 2019 Sep;12(9):773-785
pubmed: 31282773
Cell. 2021 Feb 18;184(4):861-880
pubmed: 33497610
Lancet. 2022 Feb 12;399(10325):665-676
pubmed: 35151397
JAMA. 2021 Nov 02;326(17):1690-1702
pubmed: 34606578
Lancet. 2021 May 29;397(10289):2049-2059
pubmed: 34000257
JAMA Intern Med. 2022 Feb 1;182(2):115-126
pubmed: 34901997
Blood Adv. 2022 Jun 28;6(12):3678-3683
pubmed: 35443020
J Clin Invest. 2020 Apr 1;130(4):1545-1548
pubmed: 32167489
Nat Med. 2021 Nov;27(11):2012-2024
pubmed: 34504336
JAMA Oncol. 2021 Jun 17;:
pubmed: 34137799
BMJ. 2020 Oct 22;371:m3939
pubmed: 33093056
J Clin Invest. 2021 Oct 15;131(20):
pubmed: 34473652
PLoS Med. 2021 Dec 20;18(12):e1003872
pubmed: 34928960
Nat Commun. 2022 May 11;13(1):2583
pubmed: 35546145
N Engl J Med. 2022 May 5;386(18):1700-1711
pubmed: 35353960
Am J Pathol. 2021 Jan;191(1):90-107
pubmed: 33157066
JCI Insight. 2021 Feb 22;6(4):
pubmed: 33476300
J Clin Invest. 2021 Oct 15;131(20):
pubmed: 34464352
Nat Rev Microbiol. 2004 Sep;2(9):695-703
pubmed: 15372080
Am J Hematol. 2022 Jun 1;97(6):770-779
pubmed: 35303377
Eur Respir J. 2022 Feb 10;59(2):
pubmed: 34446469
JAMA Netw Open. 2022 Jan 4;5(1):e2147375
pubmed: 35076698
JAMA. 2021 Mar 23;325(12):1185-1195
pubmed: 33635310
J Clin Invest. 2021 Dec 15;131(24):
pubmed: 34788233
N Engl J Med. 2021 Mar 18;384(11):1015-1027
pubmed: 33523609
J Infect Dis. 2021 Sep 17;224(6):967-975
pubmed: 34153099
Int J Infect Dis. 2021 Aug;109:114-117
pubmed: 34157385
Cochrane Database Syst Rev. 2021 May 20;5:CD013600
pubmed: 34013969
Ann Intern Med. 2022 Feb;175(2):234-243
pubmed: 34928698
N Engl J Med. 2020 Dec 17;383(25):2451-2460
pubmed: 32412710
J Clin Invest. 2021 Oct 15;131(20):
pubmed: 34464358
JAMA Netw Open. 2021 Nov 1;4(11):e2136246
pubmed: 34842924
J Clin Pathol. 2022 Aug;75(8):564-571
pubmed: 33893156
Br J Haematol. 2021 Feb;192(4):706-713
pubmed: 33482025
Clin Infect Dis. 2021 Jul 1;73(1):e208-e214
pubmed: 33038227
Transfusion. 2017 Oct;57(10):2539-2541
pubmed: 28691321
Mayo Clin Proc. 2021 May;96(5):1262-1275
pubmed: 33958057
N Engl J Med. 2021 Feb 18;384(7):619-629
pubmed: 33232588
JAMA Netw Open. 2022 Jan 4;5(1):e2147331
pubmed: 35076699
Nat Commun. 2021 May 27;12(1):3189
pubmed: 34045486
Transfus Med Rev. 2020 Jul;34(3):141-144
pubmed: 32359789
J Clin Invest. 2021 Jul 1;131(13):
pubmed: 33974559
N Engl J Med. 2021 Feb 18;384(7):610-618
pubmed: 33406353
Vox Sang. 2017 Jan;112(1):56-63
pubmed: 28001313