Risk factors for COVID-19 mortality: The effect of convalescent plasma administration

Abstract

Background Convalescent plasma, widely utilized in viral infections that induce neutralizing antibodies, has been proposed for COVID-19, and preliminary evidence shows that it might have beneficial effect. Our objective was to determine the risk factors for 28-days mortality in patients who received convalescent plasma for COVID-19 compared to those who did not, who were admitted to hospitals in Buenos Aires Province, Argentina, throughout the pandemic. Methods This is a multicenter, retrospective cohort study of 2-month duration beginning on June 1, 2020, including unselected, consecutive adult patients with diagnosed COVID-19, admitted to 215 hospitals with pneumonia. Epidemiological and clinical variables were registered in the Provincial Hospital Bed Management System. Convalescent plasma was supplied as part of a centralized, expanded access program. Results We analyzed 3,529 patients with pneumonia, predominantly male, aged 62±17, with arterial hypertension and diabetes as main comorbidities; 51.4% were admitted to the ward, 27.1% to the Intensive Care Unit (ICU), and 21.7% to the ICU with mechanical ventilation requirement (ICU-MV). 28-day mortality was 34.9%; and was 26.3%, 30.1% and 61.4% for ward, ICU and ICU-MV patients. Convalescent plasma was administered to 868 patients (24.6%); their 28-day mortality was significantly lower (25.5% vs. 38.0%, p<0.001). No major adverse effects occurred. Logistic regression analysis identified age, ICU admission with and without MV requirement, diabetes, and preexistent cardiovascular disease as independent predictors of 28-day mortality, whereas convalescent plasma administration acted as a protective factor. Conclusions Our study suggests that the administration of convalescent plasma in COVID-19 pneumonia admitted to the hospital might be associated with improved outcomes.

CONVALESCENT plasma for COVID‐19: A meta‐analysis of clinical trials and real‐world evidence

“…A total of 4728 records were identified from databases, websites and citation searching. There were 47 studies 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 fulfilled the inclusion criteria and were used for the systematic review and meta‐analysis (Figure 1 ). Of 47 included studies, 21 were clinical trials 16 , 17 , 18 ,…”

“…Of 47 included studies, 21 were clinical trials 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 60 , 61 , 62 and 26 were observational studies. 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 55 , 56 , 57 , 58 , 59 Among clinical trials, there were 18 studies published in peer‐reviewed journals 16 , 17 , 18 , 19 , 20 , 21 , …”

“…For observational studies, there were ten studies conducted in the USA 35 , 42 , 45 , 50 , 52 , 54 , 55 , 56 , 57 , 59 ; three in China 36 , 37 , 43 ; three in Poland 40 , 48 , 58 ; three in India 41 , 47 , 51 ; two in Turkey 34 , 39 ; and one each in United Arab Emirates, 38 Austria, 44 Brazil, 46 Qatar 49 and Argentina. 53 Almost of observational studies included patients with severe or critical COVID‐19 disease (Table 2 ). Overall risk of bias assessment deemed to be good for cohort and case‐control studies.…”

“…The current systemic review and meta‐analysis aimed to summarize the existing data on the efficacy of CP in COVID‐19 patients, which remains a challenge to explore treatment for SARS‐CoV‐2 pandemic to respond the increasing of the incidence of SARS‐CoV‐2 infection. According to the eligible criteria, 47 studies 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 were included and critically evaluated. Corresponding to the results of our systematic review and meta‐analysis, the CP may be effective in reducing the mortality of CP‐treated COVID‐19 patients compared with non‐CP‐treated COVID‐19 patients, especially in severe or critical patients and in Asia region.…”

Convalescent plasma therapy in obese severe COVID-19 adolescents: Two cases report

“…Some adjuvant therapies given to adults are not necessarily applicable to children because of limited studies on this matter [ 3 , 4 ]. The use of Convalescent Plasma Therapy (CPT) has been proven successful in several adult COVID-19 patients [ 5 ]. Few studies regarding CPT's safety and efficacy in children were found and only in case reports or case series.…”