Convalescent plasma treatment for patients of 80 years and older with COVID-19 pneumonia

Abstract

Background Older patients, frequently with multiple comorbidities, have a high mortality from COVID-19 infection. Convalescent plasma (CP) is a therapeutic option for these patients. Our objective is to retrospectively evaluate the efficacy and adverse events of CP treatment in this population group. Methods Forty one patients over 80 years old with COVID-19 pneumonia received CP added to standard treatment, 51.2% with high anti-SARS-CoV-2 IgG titers and 48.8% with low titers. Median time between the onset of symptoms and the infusion of plasma was 7 days (IQR 4–10). A similar group of 82 patients who received only standard treatment, during a period in which CP was not available, were selected as a control group. Results In-hospital mortality was 26.8% for controls and 14.6% for CP patients (P = 0.131) and ICU admission was 8.5% for controls and 4.9% for CP patients (P = 0.467). Mortality tended to be lower in the high-titer group (9.5%) than in the low-titer group (20%), and in patients transfused within the first 7 days of symptom onset (10%) than in patients transfused later (19.1%), although the differences were not statistically significant (P = 0.307 and P = 0.355 respectively). There was no difference in the length of hospitalization. No significant adverse events were associated with CP treatment. Conclusions Convalescent plasma treatment in patients over 80 years old with COVID-19 pneumonia was well tolerated but did not present a statistically significant difference in hospital mortality, ICU admission, or length of hospitalization. The results should be interpreted with caution as only half the patients received high-titer CP and the small number of patients included in the study limits the statistical power to detect significant differences. Trial registration CEIm Cantabria # 2020.127.

Convalescent Plasma in Older Adults with COVID-19: A Systematic Review and Meta-Analysis

“…Plasma with IgG titers of 1:3200 or higher reduced the risk of severe respiratory disease by 73%. 6) Similarly, Romon et al 10) reported in-hospital mortality rates of 26.8% for controls and 14.6% for patients administered CP (p = 0.131). Moreover, the ICU admission rates were 8.5% and 4.9%, respectively (p = 0.467).…”

“…1 ). 1 , 6 , 10 ) The characteristics of the included studies are presented in Table 1 . The critical appraisals for each study are presented in Table 2 .…”

“…Libster et al 6 ) included patients with at least one of each sign or symptom in the following two categories for <48 hours: a temperature of at least 37.5°C, unexplained sweating, or chills and dry cough, dyspnea, fatigue, myalgia, anorexia, sore throat, dysgeusia, anosmia, or rhinorrhea. Romon et al 10 ) included all adult patients with COVID-19 with radiologically confirmed pneumonia according to the criteria of the patient’s physician and ability to receive standard treatment.…”

“…The median lengths of stay in the CP and control groups were 11 (9–16) and 11 (7.5–16) days, respectively (p=0.073). 10 )…”

“…Mortality tended to be lower in the high-titer group (9.5%) than in the low-titer group (20%) and in patients transfused within the first 7 days of symptom onset (10%) than in patients transfused later (19.1%). 10) Franchini et al 1) reported that 22 patients with COVID-19 were transfused with 30 CP units (median 1; IQR 1-2): 15 patients (68.2%) with one CP unit, six (27.3%) with two CP units, and one (4.5%) with three CP units. Each unit contained 300 mL.…”