Klassen Stephen A, Senefeld Jonathon W, Senese Katherine A, Johnson Patrick W, Wiggins Chad C, Baker Sarah E, van Helmond Noud, Bruno Katelyn A, Pirofski Liise-Anne, Shoham Shmuel, Grossman Brenda J, Henderson Jeffrey P, Wright R Scott, Fairweather DeLisa, Paneth Nigel S, Carter Rickey E, Casadevall Arturo, Joyner Michael J
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States.
Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, United States.
Front Med (Lausanne). 2021 Jun 7;8:684151. doi: 10.3389/fmed.2021.684151. eCollection 2021.
Convalescent plasma has been used worldwide to treat patients hospitalized with coronavirus disease 2019 (COVID-19) and prevent disease progression. Despite global usage, uncertainty remains regarding plasma efficacy, as randomized controlled trials (RCTs) have provided divergent evidence regarding the survival benefit of convalescent plasma. Here, we argue that during a global health emergency, the mosaic of evidence originating from multiple levels of the epistemic hierarchy should inform contemporary policy and healthcare decisions. Indeed, worldwide matched-control studies have generally found convalescent plasma to improve COVID-19 patient survival, and RCTs have demonstrated a survival benefit when transfused early in the disease course but limited or no benefit later in the disease course when patients required greater supportive therapies. RCTs have also revealed that convalescent plasma transfusion contributes to improved symptomatology and viral clearance. To further investigate the effect of convalescent plasma on patient mortality, we performed a meta-analytical approach to pool daily survival data from all controlled studies that reported Kaplan-Meier survival plots. Qualitative inspection of all available Kaplan-Meier survival data and an aggregate Kaplan-Meier survival plot revealed a directionally consistent pattern among studies arising from multiple levels of the epistemic hierarchy, whereby convalescent plasma transfusion was generally associated with greater patient survival. Given that convalescent plasma has a similar safety profile as standard plasma, convalescent plasma should be implemented within weeks of the onset of future infectious disease outbreaks.
康复期血浆已在全球范围内用于治疗因2019冠状病毒病(COVID-19)住院的患者,并预防疾病进展。尽管在全球范围内都在使用,但血浆疗效仍存在不确定性,因为随机对照试验(RCT)提供了关于康复期血浆生存获益的不同证据。在此,我们认为,在全球卫生紧急情况期间,来自认知层次多个层面的证据拼图应指导当代政策和医疗决策。事实上,全球范围内的配对对照研究普遍发现康复期血浆可提高COVID-19患者的生存率,随机对照试验表明,在病程早期输血可带来生存获益,但在病程后期,当患者需要更多支持性治疗时,获益有限或无获益。随机对照试验还表明,康复期血浆输血有助于改善症状和病毒清除。为了进一步研究康复期血浆对患者死亡率的影响,我们采用了荟萃分析方法,汇总了所有报告Kaplan-Meier生存曲线的对照研究的每日生存数据。对所有可用的Kaplan-Meier生存数据进行定性检查以及汇总的Kaplan-Meier生存曲线显示,来自认知层次多个层面的研究呈现出方向一致的模式,即康复期血浆输血通常与更高的患者生存率相关。鉴于康复期血浆的安全性与标准血浆相似,应在未来传染病暴发数周内采用康复期血浆治疗。