Improved clinical symptoms and mortality among patients with severe or critical COVID-19 after convalescent plasma transfusion

Abstract

Coronavirus disease 2019 (COVID-19) is causing worldwide pandemic with no specific therapeutic agents, especially for severe or critical patients. To comprehensively evaluate the effectiveness, safety, and indications of convalescent plasma transfusion (CPT) therapy for severe or critical COVID-19 patients, we analyzed the clinical, laboratory, and radiologic characteristics of 1,568 patients from a single center, in which 138 patients received ABO-compatible CPT. The median time from the first symptom to CPT was 45 days. 2.2% and 4.1% of cases died in the CPT group and in the standard-treatment group, respectively. 2.4% and 5.1% of patients in the CPT and the standard-treatment group have been admitted to ICU eventually. 70% of the patients who had severe respiratory symptoms got improved and removed oxygen supports within 7 days after CPT. The viral loads and C-reactive protein (CRP) concentration significantly decreased (P<0.001), and the percentage of lymphocytes increased (P=0.006), 76.8% of cases received radiological improvements within 14 days after CPT. Patients with a higher percentage of lymphocytes and a lower percentage of neutrophils and CRP concentration respond better to CPT (P<0.05). Notably, for the patients who received CPT within 7 weeks after symptom onset, the median time from CPT to clinical improvements was approximately 10 days. But the time to clinical improvements was significantly prolonged for patients who received CPT later than 7 weeks after onset. Our study will provide important information for the clinical practice in COVID-19 treatment, as well as provide real-world observations and clinical data for the development of monoclonal antibodies.

Humoral immune responses and neutralizing antibodies against SARS-CoV-2; implications in pathogenesis and protective immunity

“…The fact that higher titers of total and neutralizing antibodies are observed in severe cases of SARS-CoV and SARS-CoV-2 infection [ 13 , 59 , 60 ], suggests that ADE might contribute to severity. Although in vitro and in vivo evidence exist for a role of during SARS-CoV infection [ [61] , [62] , [63] , [64] ], current observations do not support a strong contribution of to COVID-19 severity: 1) the infusion of convalescent plasma in COVID19 patients have not reveled any adverse effect [ [49] , [50] , [51] , [52] ]; 2) non-human primates develop antibodies against SARS-CoV-2 and are resistant to reinfection [ 65 ]; and 3) vaccinated animals develop antibodies and do not show signs of after challenge [ 66 , 67 ].…”

“…As mentioned above, neutralizing antibodies are protective as demonstrated in different animal models [ [39] , [40] , [41] , [42] , [43] ]. Accordingly, the administration of convalescent plasma to COVID19+ individuals improve their clinic status, at least in those treated with High neutralizing plasma during early disease stages [ [49] , [50] , [51] , [52] ]. Actually, no clinical benefit was observed in those patients requiring invasive mechanical ventilation [ 50 ].…”

“…Accordingly, the administration of convalescent plasma to COVID19+ individuals improve their clinic status, at least in those treated with High neutralizing plasma during early disease stages [ [49] , [50] , [51] , [52] ]. Actually, no clinical benefit was observed in those patients requiring invasive mechanical ventilation [ 50 ]. An additional indirect evidence about the antiviral activity of neutralizing antibodies in vivo is the identification of escape mutations that avoid the binding of neutralizing antibodies [ 53 ].…”

Diabetes Patients of COVID-19 Infection Treated with Convalescent Plasma Transfusion in Wuhan, China

“…It has recently been suggested by US Food and Drug Administration (FDA) that administration and study of investigational CPT may provide a clinical effect for treatment of COVID-19 during the public health emergency. We had also conducted a system study to evaluate available data of Wuhan Huoshenshan Hospital of China for the clinical effectiveness of convalescent plasma for COVID-19 infection [30]. And in this study, an investigation of CPT therapy for COVID-19 patients with diabetes comorbidity was conducted.…”

Knowing When and How to Fight: COVID-19 Between Viral Clearance and Immune Tolerance

“…A large retrospective study from China also reports clinical improvement. 87 However, recent meta-analysis has demonstrated the difficulty to draw conclusion of CP efficacy due to lack of clear results obtained from existing randomized clinical trial. 88 Recent clinical trial has been discontinued due to difficulty to recruit severe patients as subjects, ironically as a result of successful lockdown.…”