Writing Committee for the REMAP-CAP Investigators IMPORTANCE The evidence for benefit of convalescent plasma for critically ill patients with COVID-19 is inconclusive.OBJECTIVE To determine whether convalescent plasma would improve outcomes for critically ill adults with COVID-19. DESIGN, SETTING, AND PARTICIPANTSThe ongoing Randomized, Embedded, Multifactorial, Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) enrolled and randomized 4763 adults with suspected or confirmed COVID-19 between March 9, 2020, and January 18, 2021, within at least 1 domain; 2011 critically ill adults were randomized to open-label interventions in the immunoglobulin domain at 129 sites in 4 countries. Follow-up ended on April 19, 2021. INTERVENTIONSThe immunoglobulin domain randomized participants to receive 2 units of high-titer, ABO-compatible convalescent plasma (total volume of 550 mL ± 150 mL) within 48 hours of randomization (n = 1084) or no convalescent plasma (n = 916). MAIN OUTCOMES AND MEASURESThe primary ordinal end point was organ support-free days (days alive and free of intensive care unit-based organ support) up to day 21 (range, −1 to 21 days; patients who died were assigned -1 day). The primary analysis was an adjusted bayesian cumulative logistic model. Superiority was defined as the posterior probability of an odds ratio (OR) greater than 1 (threshold for trial conclusion of superiority >99%). Futility was defined as the posterior probability of an OR less than 1.2 (threshold for trial conclusion of futility >95%). An OR greater than 1 represented improved survival, more organ support-free days, or both. The prespecified secondary outcomes included in-hospital survival; 28-day survival; 90-day survival; respiratory support-free days; cardiovascular support-free days; progression to invasive mechanical ventilation, extracorporeal mechanical oxygenation, or death; intensive care unit length of stay; hospital length of stay; World Health Organization ordinal scale score at day 14; venous thromboembolic events at 90 days; and serious adverse events. RESULTS Among the 2011 participants who were randomized (median age, 61 [IQR, 52 to 70] years and 645/1998 [32.3%] women), 1990 (99%) completed the trial. The convalescent plasma intervention was stopped after the prespecified criterion for futility was met. The median number of organ support-free days was 0 (IQR, -1 to 16) in the convalescent plasma group and 3 (IQR, -1 to 16) in the no convalescent plasma group. The in-hospital mortality rate was 37.3% (401/1075) for the convalescent plasma group and 38.4% (347/904) for the no convalescent plasma group and the median number of days alive and free of organ support was 14 (IQR, 3 to 18) and 14 (IQR, 7 to 18), respectively. The median-adjusted OR was 0.97 (95% credible interval, 0.83 to 1.15) and the posterior probability of futility (OR <1.2) was 99.4% for the convalescent plasma group compared with the no convalescent plasma group. The treatment effects were consistent across the primary outcome and the 11...
of findings for the main comparison. Summary of findings 1. INTERCESSORY PRAYER (CONTEMPORANEOUS) versus STANDARD CARE INTERCESSORY PRAYER (CONTEMPORANEOUS) versus STANDARD CARE for various illnesses Patient or population: patients with various illnesses Settings: in hospital Intervention: INTERCESSORY PRAYER (CONTEMPORANEOUS) versus STANDARD CARE Illustrative comparative risks* (95% CI) Outcomes Assumed risk Corresponding risk Relative effect (95% CI) No of Participants (studies) Quality of the evidence (GRADE) Comments Control INTERCESSORY PRAYER (CONTEMPORANEOUS) versus STANDARD CARE Medium risk population Death by end of trial 96 per 1000 69 per 1000 (36 to 132) RR 0.72 (0.38 to 1.38) 3389 (5) ⊕⊕⊝⊝ low 1,2 Medium risk population Clinical state: 1. Improved/not improved: intermediate or bad outcome 269 per 1000 264 per 1000 (231 to 299) RR 0.98 (0.86 to 1.11) 2705 (5) ⊕⊕⊝⊝ low 1,2 Medium risk population Clinical state: 2. Significant complications (readmission to CCU) 84 per 1000 84 per 1000 (65 to 109) RR 1 (0.77 to 1.3) 2644 (4) ⊕⊕⊕⊝ moderate 1 Medium risk population Leaving the study early 2 per 1000 2 per 1000 (1 to 3) RR 0.75 (0.43 to 1.31) 3446 (6) ⊕⊕⊕⊝ moderate 1 *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
Objectives: To review the effectiveness of prayer as an additional intervention for those with health problems already receiving standard medical care. Search Strategy: Electronic Searches of Biological Abstracts, CINAHL, The Cochrane Controlled Trials Register, EM-BASE, MEDLINE, PsycLIT, and Sociofile were undertaken. All references of articles selected were searched for further relevant trials. Selection Criteria: Randomised and quasi-randomised trials of personal, focused, committed and organised intercessory prayer on behalf of anyone with a health problem were considered. Outcomes such as achievement of desired goals, death, illness, quality of life and well-being for the recipients of prayer, those praying and the caregivers were sought. Data Collection and Analysis: Studies were reliably selected and assessed for methodological quality. Data were extracted by 4 reviewers working independently. Dichotomous data were analysed on an intention-to-treat basis, and continuous data with over 50% completion rate are presented. Main Results: There was no evidence that prayer affected the numbers of people dying from leukaemia or heart disease (OR 0.64, CI 0.32–1.27), or that it decreased coronary care complications (OR 1.05, CI 0.49–2.26) or the time participants stayed in hospital. There were significantly fewer ‘intermediat//poor outcomes’ for those with heart disease in the prayed-for group (OR 0.49, CI 0.30–0.80), and this finding was robust to some changes in definition. Conclusions: This review provides no guidance for those wishing to uphold or refute the effect of intercessory prayer on the outcomes studied in the available trials. Therefore, in the light of the best available data, there are no grounds to change current practices. There are very few completed trials of the value of intercessory prayer. The evidence presented so far is interesting enough to justify further study. If prayer is seen as a human endeavour it may or may not be beneficial, and further trials could uncover this. It could be the case that any effects are due to elements beyond present scientific understanding that will, in time, be understood. If any benefit derives from God’s response to prayer it may be beyond any such trials to prove or disprove.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.